CPT 99281 Emergency Medicine
Emergency department visit - straightforward Cost
Body System: General
Medicare Facility Rate
$30
CMS PFS CY2026
Medicare Non-Facility Rate
$60
Office/clinic setting
Hospital Outpatient
$86
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.48
Work RVU
0.40
Facility PE RVU
0.06
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| US — Carrier 01112 Locality 05 | $12 | $18 — $30 |
| US — Carrier 01112 Locality 09 | $12 | $18 — $30 |
| US — Carrier 01112 Locality 51 | $12 | $17 — $29 |
| US — Carrier 01112 Locality 52 | $12 | $18 — $30 |
| US — Carrier 01112 Locality 53 | $12 | $17 — $29 |
| US — Carrier 01112 Locality 54 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 55 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 56 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 57 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 58 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 59 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 60 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 61 | $11 | $16 — $27 |
| US — Carrier 01112 Locality 62 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 63 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 64 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 65 | $12 | $18 — $31 |
| US — Carrier 01112 Locality 66 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 67 | $11 | $17 — $28 |
| US — Carrier 01112 Locality 68 | $11 | $16 — $27 |
Frequently Asked Questions
How much does Emergency department visit - straightforward cost?
The Medicare facility rate is $30. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $86.
How much does Emergency department visit - straightforward cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $30.