CPT 99285 Emergency Medicine
Emergency department visit - high complexity Cost
Body System: General
Medicare Facility Rate
$192
CMS PFS CY2026
Medicare Non-Facility Rate
$293
Office/clinic setting
Hospital Outpatient
$608
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
3.80
Work RVU
1.60
Facility PE RVU
0.52
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $257 | $385 — $642 |
| AL — ALABAMA | $184 | $275 — $459 |
| AR — ARKANSAS | $182 | $273 — $454 |
| AZ — ARIZONA | $194 | $290 — $484 |
| AZ — Phoenix | $196 | $294 — $490 |
| CA — BAKERSFIELD | $198 | $298 — $496 |
| CA — CHICO | $197 | $295 — $492 |
| CA — EL CENTRO | $197 | $296 — $493 |
| CA — FRESNO | $197 | $295 — $492 |
| CA — HANFORD-CORCORAN | $197 | $295 — $492 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $207 | $310 — $517 |
| CA — Los Angeles | $210 | $315 — $526 |
| CA — MADERA | $197 | $295 — $492 |
| CA — MERCED | $197 | $295 — $492 |
| CA — MODESTO | $197 | $295 — $492 |
| CA — NAPA | $214 | $321 — $535 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $204 | $307 — $511 |
| CA — REDDING | $197 | $295 — $492 |
| CA — REST OF CALIFORNIA | $197 | $295 — $492 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $203 | $304 — $506 |
Frequently Asked Questions
How much does Emergency department visit - high complexity cost?
The Medicare facility rate is $192. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $608.
How much does Emergency department visit - high complexity 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 $192.