Emergency Department Visit, Low Complexity (Level 3)
CPT 99283 is a Level 3 emergency department visit requiring low complexity medical decision making. The average total charge is $2,160.03, but the Medicare physician fee is only $69.47. That apparent 31.1x markup is misleading because the average charge includes the hospital facility fee (typically $500 to $2,000), while the Medicare rate covers only the physician portion. Your total ER bill is the sum of the physician fee, the facility fee, and any tests or procedures performed during the visit.
CPT 99283 at a Glance
- Average total charge: $2,160.03
- Medicare physician fee: $69.47
- Hospital facility fee: $500 to $2,000 (billed separately)
- Apparent markup: 31.1x (includes facility fee in charge)
- ER Level: 3 of 5
- Decision complexity: Low
- Setting: Emergency department (always facility)
- Global days: XXX (no post-op period)
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How the Medicare Physician Fee Is Calculated
Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For ER visits, the office and facility rates are the same because emergency departments are always facility settings. Here is the exact math for the physician portion of a 99283 visit:
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Physician time, skill, and judgment | 1.60 |
| Practice Expense RVU (Facility) | Physician overhead in facility setting | 0.28 |
| Malpractice RVU | Professional liability insurance | 0.20 |
| Total RVU | 2.08 | |
| x $33.4009 | 2026 conversion factor | $69.47 |
Why the Average Charge Is 31x the Medicare Physician Fee
The $2,160.03 average charge for a 99283 visit looks extreme compared to the $69.47 Medicare physician fee, but these numbers are not directly comparable. Here is what makes up a typical ER bill:
| Bill Component | What It Covers | Typical Range |
|---|---|---|
| Physician professional fee | The ER doctor's evaluation and management | $69 to $350 |
| Hospital facility fee | ER room, nursing, monitoring, equipment | $500 to $2,000 |
| Labs and imaging | Blood work, X-rays, CT scans if ordered | $0 to $3,000+ |
| Procedures and supplies | IV fluids, medications, splints, wound care | $0 to $1,000+ |
The average charge of $2,160.03 bundles all of these together. The Medicare physician fee of $69.47 covers only the first line item. This is why the ratio appears so extreme. The real physician markup is much lower, but the total bill is driven primarily by the facility fee and any ancillary services.
Medicare Physician Fee by State
Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). The same 99283 physician fee varies by state, from about $65 in Arkansas to $94 in Alaska. Remember, this is only the physician portion. The hospital facility fee is separate and also varies by location.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates (Physician Fee Only)
| State | Medicare Physician Fee | Avg. Total Charge | Apparent Ratio |
|---|---|---|---|
| Texas (Austin) | $69.36 | $2,160.03 | 31.1x |
| California (Los Angeles) | $71.13 | $2,160.03 | 30.4x |
| New York (Manhattan) | $78.32 | $2,160.03 | 27.6x |
| Florida (Fort Lauderdale) | $74.99 | $2,160.03 | 28.8x |
| Ohio | $68.71 | $2,160.03 | 31.4x |
| Mississippi | $66.43 | $2,160.03 | 32.5x |
| Arkansas | $64.91 | $2,160.03 | 33.3x |
| Alaska | $93.80 | $2,160.03 | 23.0x |
Physician fees shown use 2026 GPCIs and the $33.4009 conversion factor. ER visits are always facility setting, so the non-facility rate does not apply. The average charge of $2,160.03 is the 2023 national average from CMS utilization data and includes both physician and facility components. The apparent ratio is high because it compares total charges to physician-only fees.
What Insured Patients Actually Pay for a 99283 ER Visit
Most insurance plans have a flat ER copay that applies regardless of the visit level. Your total out-of-pocket depends on your plan design and whether you have met your deductible. Many plans waive the ER copay entirely if you are admitted to the hospital from the ER.
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met or N/A) | $150 to $500 | Flat ER copay, plus possible coinsurance on facility and ancillary charges |
| Coinsurance plan (deductible met) | $200 to $600 | 20% of the negotiated total (physician + facility + ancillaries) |
| High-deductible plan (deductible NOT met) | $800 to $2,000+ | Full negotiated rate for all components until your deductible is met |
| Medicare Part B | $13.89 + facility share | 20% of the physician fee ($69.47), plus 20% of the facility portion |
| Admitted from ER | ER copay often waived | Many plans waive the ER copay if you are admitted, shifting to inpatient cost-sharing instead |
Common ER Billing Problems
ER level upcoding
Hospitals assign ER visit levels, not the treating physician. Many hospitals use automated "facility coding" systems that tend to assign Level 4 (99284) or Level 5 (99285) to maximize revenue. A 2023 OIG report found that Level 5 billing increased from 28% to 38% of all ER visits over a decade, while Level 3 (99283) billing dropped. If your visit was straightforward (a minor injury, simple infection, or brief evaluation), it may have been inappropriately coded at a higher level. Request the medical records and compare the documented complexity to the billed level.
Facility fee shock (two bills for one visit)
Many patients expect one bill from the ER but receive two: one from the emergency physician (or their group) and a separate one from the hospital for the facility fee. The physician bill for a 99283 might be $150 to $350, but the hospital facility bill can be $500 to $2,000 on top of that. These arrive separately, sometimes weeks apart, which adds to the confusion. Always expect at least two bills from any ER visit, and request an itemized statement from both.
Freestanding ERs billing ER rates
Some states have freestanding emergency rooms that look like urgent care centers but bill at full ER rates. A patient who walks in for a minor issue (sore throat, sprained ankle) may receive a bill of $1,500 or more because the facility bills ER-level codes like 99283 instead of the much cheaper urgent care E/M codes. Before visiting any facility, check whether it is an urgent care center or a freestanding ER. The difference can be thousands of dollars.
Ancillary charges that exceed the visit itself
The ER visit code (99283) is often a small fraction of the total bill. A single CT scan can add $1,000 to $3,000. Blood work panels can add $200 to $800. IV fluids and medications are billed individually. Always request an itemized bill and review each line item. Duplicate charges, incorrect quantities, and charges for services not actually performed are common in ER billing.
What to Do After Your ER Visit
Unlike a planned office visit, you cannot shop around for ER pricing in advance. The focus shifts to reviewing your bill after the fact. Here is what to do:
Steps to Take
- Request an itemized bill from both the physician group and the hospital
- Compare the ER level code (99283, 99284, 99285) to what actually happened during your visit
- Check for duplicate charges, especially for supplies and medications
- Verify that all listed procedures and tests were actually performed
- Review your Explanation of Benefits (EOB) from your insurer for discrepancies
Red Flags on Your Bill
- Level 4 or 5 code for a brief, straightforward visit
- Facility fee over $2,000 for a visit where you spent less than an hour
- Charges for imaging or labs you do not remember receiving
- Separate charges for supplies that should be bundled into the facility fee
- Balance billing from an out-of-network physician (protected by No Surprises Act)
Related Emergency Department Codes
| Code | Description | Medicare Physician Fee | Avg. Total Charge |
|---|---|---|---|
| 99281 | ER Level 1 (minimal, rarely billed) | - | - |
| 99282 | ER Level 2 (straightforward, rarely billed) | - | - |
| 99283 | ER Level 3, low complexity | $69.47 | $2,160.03 |
| 99284 | ER Level 4, moderate complexity | $118.24 | $1,762.83 |
| 99285 | ER Level 5, high complexity | $171.35 | $2,208.99 |
99281 and 99282 exist but are rarely used. Most ER visits are billed at Level 3 (99283) through Level 5 (99285). Average charges include both physician and facility components.
Frequently Asked Questions
How much does a 99283 ER visit cost without insurance?
The average total charge for a CPT 99283 ER visit is $2,160.03, which includes both the physician fee and the hospital facility fee. Without insurance, you may be able to negotiate a lower total. Many hospitals offer a self-pay discount of 30 to 60% off billed charges, and most are required to provide financial assistance information. Request an itemized bill and ask about their charity care or prompt-pay discount programs.
Why is the ER bill so much higher than the Medicare rate?
The Medicare rate of $69.47 covers only the physician's professional fee. The hospital bills a separate facility fee ($500 to $2,000) for the ER room, nursing staff, equipment, and overhead. The average charge of $2,160.03 includes both components plus any ancillary services. When you compare the total charge to just the physician fee, the ratio looks extreme (31.1x), but the physician fee was never intended to represent the full cost of an ER visit.
What is the difference between 99283, 99284, and 99285?
These codes represent ER visit levels based on medical decision making complexity. 99283 (Level 3) is low complexity, 99284 (Level 4) is moderate complexity, and 99285 (Level 5) is high complexity. The Medicare physician fees are $69.47, $118.24, and $171.35 respectively. The hospital, not the physician, typically assigns the level. A 2023 OIG report found that hospitals have been shifting billing toward higher levels over the past decade.
Does the No Surprises Act protect me from ER balance billing?
Yes. Since January 2022, the No Surprises Act prohibits balance billing for emergency services. If your ER physician is out-of-network, you can only be charged your in-network cost-sharing amount (copay, coinsurance, or deductible). The physician and your insurer must resolve any payment dispute between themselves. This applies to all emergency services at hospital ERs and freestanding emergency departments.
Got a High ER Bill? We Can Help.
ER bills are complex, with multiple providers, facility fees, and ancillary charges that are easy to overcount. CareRoute Bill Defense analyzes every line item on your bill, identifies coding errors and overcharges, and negotiates reductions on your behalf. ER bills are where we consistently find the most savings.
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