CPT 99284: ED visit, moderate-high
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 99284?
A moderate-to-high complexity ER visit — used when multiple diagnostics were required or the problem was potentially serious.
Typical setting: Hospital emergency department.
What CPT 99284 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $232 for CPT 99284 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($278–$418). Hospital chargemaster prices for CPT 99284 often range from $400 to $1200 — a markup of 1.7x to 5.2x over Medicare.
Common overcharges on CPT 99284
Frequently upcoded to 99285. Request the physician's notes — if the ED record does not describe a high-complexity medical decision, the correct code is 99284, not 99285.
About Emergency billing
Emergency room visits are among the most overcharged medical services in the U.S. ER billing combines a physician E&M code with a hospital facility fee — and the facility fee alone can run $500 to $3,000.
Request the itemized bill (UB-04) and the ED physician's documentation. If the medical decision-making does not support the billed level, demand a downcode. Out-of-network ER billing above in-network rates is illegal under the No Surprises Act.
How to dispute a CPT 99284 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($348), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 99284 on your bill?
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