Cost analysis for CPT 99285 — Emergency department visit, problem with significant threat to life or function
Average Medicare Payment
$133.30
2023 data
Total Payments (2023)
$1.2B
Services (2023)
8.5M
Price Change (2014–2023)
+3.2%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $129.19 | $1.4B | 10.8M | — |
| 2015 | $130.97 | $1.5B | 11.2M | +1.4% |
| 2016 | $129.47 | $1.5B | 11.6M | -1.1% |
| 2017 | $130.50 | $1.6B | 11.7M | +0.8% |
| 2018 | $129.13 | $1.5B | 11.5M | -1.0% |
| 2019 | $129.71 | $1.5B | 11.4M | +0.4% |
| 2020 | $137.34 | $1.3B | 9.2M | +5.9% |
| 2021 | $146.11 | $1.4B | 9.1M | +6.4% |
| 2022 | $142.23 | $1.3B | 9.0M | -2.7% |
| 2023 | $133.30 | $1.2B | 8.5M | -6.3% |
The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $180.90 vs VI at $117.73.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $180.90 | $3.7M | 20.7K | 132 |
| AA | $151.01 | $21.7K | 144 | 4 |
| NY | $149.10 | $79.6M | 533.6K | 4.1K |
| AP | $148.12 | $156.6K | 1.1K | 10 |
| DC | $146.98 | $4.0M | 27.1K | 251 |
| NJ | $145.67 | $38.3M | 263.0K | 1.5K |
| CT | $142.55 | $14.0M | 98.5K | 795 |
| MA | $142.15 | $38.1M | 267.8K | 1.6K |
| IL | $142.08 | $61.0M | 429.1K | 2.6K |
| MD | $141.78 | $26.0M | 183.3K | 1.1K |
| FL | $141.64 | $84.2M | 594.1K | 3.9K |
| PR | $141.27 | $1.1M | 8.0K | 69 |
| DE | $140.67 | $7.4M | 52.6K | 224 |
| CA | $139.89 | $105.6M | 755.0K | 5.3K |
| MI | $139.22 | $50.6M | 363.1K | 2.7K |
| RI | $139.20 | $6.0M | 43.2K | 284 |
| GU | $138.04 | $258.1K | 1.9K | 17 |
| PA | $137.37 | $65.5M | 476.5K | 3.2K |
| WA | $137.36 | $17.1M | 124.4K | 1.0K |
| NV | $135.95 | $8.8M | 64.4K | 495 |
| OH | $135.38 | $51.4M | 379.5K | 2.7K |
| LA | $135.16 | $18.8M | 139.1K | 1.1K |
| AE | $134.66 | $157.0K | 1.2K | 9 |
| CO | $134.58 | $14.1M | 104.7K | 1.0K |
| GA | $134.42 | $29.7M | 220.6K | 1.7K |
| NM | $134.34 | $5.9M | 43.7K | 406 |
| TX | $134.20 | $71.0M | 529.1K | 4.3K |
| VA | $134.07 | $31.7M | 236.7K | 1.6K |
| NH | $133.72 | $5.1M | 38.1K | 302 |
| ME | $133.68 | $4.3M | 31.8K | 340 |
| ZZ | $133.55 | $122.9K | 920 | 7 |
| MT | $133.54 | $3.4M | 25.7K | 154 |
| AZ | $133.23 | $20.6M | 154.8K | 1.2K |
| ND | $133.21 | $2.6M | 19.1K | 113 |
| WV | $133.14 | $6.5M | 49.1K | 421 |
| MO | $133.04 | $21.7M | 163.3K | 1.2K |
| OR | $132.39 | $9.4M | 70.9K | 683 |
| SC | $131.56 | $22.8M | 173.0K | 1.1K |
| MS | $131.33 | $12.8M | 97.1K | 547 |
| KY | $131.17 | $19.0M | 145.2K | 1.0K |
| UT | $131.12 | $5.8M | 44.3K | 457 |
| HI | $130.95 | $2.8M | 21.2K | 192 |
| VT | $130.64 | $2.1M | 16.0K | 129 |
| NC | $130.36 | $37.3M | 286.3K | 2.2K |
| OK | $129.36 | $16.5M | 127.8K | 786 |
| MN | $129.30 | $15.9M | 122.9K | 1.2K |
| TN | $129.24 | $23.7M | 183.0K | 1.3K |
| SD | $129.16 | $2.7M | 21.2K | 134 |
| AL | $128.87 | $14.0M | 108.3K | 827 |
| IN | $128.85 | $25.6M | 198.3K | 1.4K |
| WY | $128.45 | $1.7M | 13.5K | 92 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Ruslan Ivanov | Family Practice | FL | $178.2K | 1.3K | $142.19 |
| Theresa Gandor | Emergency Medicine | IL | $164.8K | 1.0K | $158.15 |
| Daniel Montgomery | Emergency Medicine | SD | $150.5K | 1.1K | $136.46 |
| Matthew Leonard | Emergency Medicine | NC | $149.0K | 952 | $156.56 |
| Todd Templeman | Emergency Medicine | DC | $148.6K | 929 | $159.92 |
| Juan Acosta | Emergency Medicine | NY | $143.1K | 841 | $170.13 |
| Nicole Nembhard | Emergency Medicine | NY | $140.2K | 816 | $171.83 |
| Kenneth Mclaughlin | Emergency Medicine | MA | $139.5K | 974 | $143.19 |
| Imraan Haniff | Emergency Medicine | OH | $139.4K | 1.0K | $136.65 |
| James Aron | Emergency Medicine | MS | $139.1K | 1.1K | $132.23 |
| James Arnold | Emergency Medicine | AR | $139.1K | 1.1K | $129.01 |
| David Romanelli | Emergency Medicine | NY | $136.6K | 839 | $162.85 |
| Shannon Reeve | Emergency Medicine | MD | $136.3K | 858 | $158.84 |
| Sayed Khwaja | Emergency Medicine | NY | $136.2K | 803 | $169.65 |
| Nicole Pomerantz | Emergency Medicine | MI | $135.5K | 927 | $146.22 |
| Cindy Li | Emergency Medicine | NY | $133.6K | 791 | $168.93 |
| Gerald Stell | Family Practice | LA | $133.5K | 968 | $137.94 |
| Khoi Lam | Emergency Medicine | CA | $133.4K | 907 | $147.05 |
| Frank Tresgallo | Emergency Medicine | FL | $132.3K | 878 | $150.69 |
| Daniel Dawson | Emergency Medicine | AZ | $132.2K | 966 | $136.82 |
Based on the data, CPT 99285 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.
Costs have increased 3.2% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.