CPT 99285: ER visit, level 5. What Medicare pays and what to ask
If you see 99285 on a hospital bill, the emergency department billed its highest standard visit level. Here is what the code covers, the national Medicare rate for it, and the questions worth asking before you pay.
What this code means
CPT 99285 is the top of the five emergency department visit levels. It is used when the medical decision making is high, for example for a problem that may threaten life or the function of a body part.
It describes the clinician's evaluation and management of the visit. Tests, imaging, IV medications and procedures are billed on their own lines.
Why the bill can be much higher than the Medicare rate
The rate on this page is the physician fee schedule amount. A hospital may also bill a separate facility charge for the visit, which this rate does not include.
Hospitals start from their own price list, the chargemaster, so the first bill is often far above any published benchmark. The Medicare rate is a reference point, not a legal limit on what a hospital may charge.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $856.75 |
| 10x the Medicare rate | $1,713.50 |
| 20x the Medicare rate | $3,427.00 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- What in my visit supported level 5 instead of level 4 (99284)?
- Am I being billed both a facility charge and a physician charge for this visit, and what is each one?
- Is this visit listed only once on the bill?
- Can you send the itemized bill, the discounted cash price and the financial assistance policy?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.