What is the difference between 99284 and 99285?

Both are emergency department visit codes. 99285 is the highest of the five levels and 99284 the next one down; the level reflects how complex the visit was as documented.

Why is there a separate bill from the ER doctor?

Emergency physicians are often part of a separate group that bills for their own services, apart from the hospital’s facility bill.

Am I protected from surprise ER bills?

CMS says the No Surprises Act protects most insured people from unexpected out-of-network bills for emergency room visits.

ER VISIT LEVELS

What do ER visit codes 99281–99285 mean on my bill?

CPT codes 99281 to 99285 are the five levels used to bill an emergency department visit, from the least to the most complex. The level reflects how complex the visit was judged to be — not how long you waited — and a higher level usually means a higher charge.

Why it’s confusing

The level often appears as just “ER visit level 4” or “ED VISIT 99284”, and people assume it is a rating of how sick they were or how long they spent there.

The level is for the evaluation and management part of the visit. Tests, scans, drugs and procedures are billed on their own lines, so one ER visit can produce a long bill.

How to read it

Find the visit line on the itemized bill. It may appear on the hospital’s bill, and a similar code may appear on a separate bill from the emergency physician group.

Read the level as a billing category: 99281 is the lowest, 99285 the highest. The level is chosen from the visit’s documentation.

If the level seems high for what happened, it is reasonable to ask the provider how it was chosen and to see the documentation it was based on.

What it does not mean

That the level is a measure of how serious your condition was. It is about the complexity of the visit as documented.
That waiting longer means a higher level. Waiting time isn’t what it measures.
That it is the whole charge for the visit. Tests and treatment are billed separately.

Where you’ll see it

Hospital itemized bills, on the emergency department visit line.
Bills from emergency physician groups.
Insurance EOBs, as the procedure code for the visit.

Questions worth asking

Ask the billing office

Which visit level was billed, and how was it chosen?
Is there a separate bill from the emergency physician?
Has my insurer’s payment been applied?

Got an ER bill you can’t follow? Attach it or take a photo, and Clariti will explain each line.

Explain my document See an example analysis first

Your first 3 analyses are free. Also on Android and iPhone.

Common questions

What is the difference between 99284 and 99285?: Both are emergency department visit codes. 99285 is the highest of the five levels and 99284 the next one down; the level reflects how complex the visit was as documented.
Why is there a separate bill from the ER doctor?: Emergency physicians are often part of a separate group that bills for their own services, apart from the hospital’s facility bill.
Am I protected from surprise ER bills?: CMS says the No Surprises Act protects most insured people from unexpected out-of-network bills for emergency room visits.