Emergency department & critical care

99285 - RVUs & Medicare payment (2026)

Emergency department visit, level 5.

Component	Non-facility	Facility
Work RVU	4.00	4.00
Practice expense RVU	0.65	0.65
Malpractice RVU	0.48	0.48
Total RVUs	5.13	5.13
National payment (CF $33.4009)	$171.35	$171.35
Qualifying APM payment (CF $33.5675)	$172.20	$172.20

How 99285 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99285 ranges from $159.34 in Wisconsin (WI) to $232.36 in Alaska (AK); calculate 99285 for your locality.

Alaska (AK) $232.36 NYC Suburbs/Long Island (NY) $197.74 Miami (FL) $196.75 Chicago (IL) $193.15 Manhattan (NY) $192.81 Queens (NY) $190.93 San Jose-Sunnyvale-Santa Clara (CA) $188.20 San Jose-Sunnyvale-Santa Clara (CA) $185.97 National average $171.35 … 97 more localities between … Arkansas (AR) $160.51 Iowa (IA) $159.83 Nebraska (NE) $159.70 Wisconsin (WI) $159.34

Non-facility payment for 99285 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - emergency department & critical care

99281 · emergency department visit, level 1
99282 · emergency department visit, level 2
99283 · emergency department visit, level 3
99284 · emergency department visit, level 4
99291 · critical care, first 30-74 minutes
99292 · critical care, each additional 30 minutes

Frequently asked questions

How much does Medicare pay for 99285 in 2026?

The national non-facility payment is $171.35 and the facility payment is $171.35, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 99285?

The 2026 work RVU for 99285 is 4.00. Total RVUs are 5.13 in the non-facility setting and 5.13 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.