CPT 99284 Reimbursement: Medicare, Commercial, and Facility Fee Factors

CPT 99284 = Emergency department visit, high complexity (moderate-to-high severity).

Reimbursement Estimates

• Medicare (2022 national avg): ~$114.05 (varies by GPCI geographic adjustment).
• Commercial insurers: Vary widely; often 120–250% of Medicare, but depends on contract, plan, deductible/coinsurance.
• Facility fee: Separate hospital outpatient charge (APC-based); can add $500–$2,000+.

Key Variables

• Geographic region (wage index, practice cost)
• Place of service (hospital vs. freestanding ED)
• Patient insurance type and benefit design
• Modifiers (e.g., -25 for significant separate E/M)

For exact patient cost, contact the provider's billing office or insurer.