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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 99285
  4. Cost Analysis

How Much Does Emergency department visit, problem with significant threat to life or function Cost on Medicare?

Cost analysis for CPT 99285 — Emergency department visit, problem with significant threat to life or function

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Average Medicare Payment

$133.30

2023 data

Total Payments (2023)

$1.2B

Services (2023)

8.5M

Price Change (2014–2023)

+3.2%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$129.19$1.4B10.8M—
2015$130.97$1.5B11.2M+1.4%
2016$129.47$1.5B11.6M-1.1%
2017$130.50$1.6B11.7M+0.8%
2018$129.13$1.5B11.5M-1.0%
2019$129.71$1.5B11.4M+0.4%
2020$137.34$1.3B9.2M+5.9%
2021$146.11$1.4B9.1M+6.4%
2022$142.23$1.3B9.0M-2.7%
2023$133.30$1.2B8.5M-6.3%

🗺️ State-by-State Cost Variation

The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $180.90 vs VI at $117.73.

StateAvg PaymentTotal PaymentsServicesProviders
AK$180.90$3.7M20.7K132
AA$151.01$21.7K1444
NY$149.10$79.6M533.6K4.1K
AP$148.12$156.6K1.1K10
DC$146.98$4.0M27.1K251
NJ$145.67$38.3M263.0K1.5K
CT$142.55$14.0M98.5K795
MA$142.15$38.1M267.8K1.6K
IL$142.08$61.0M429.1K2.6K
MD$141.78$26.0M183.3K1.1K
FL$141.64$84.2M594.1K3.9K
PR$141.27$1.1M8.0K69
DE$140.67$7.4M52.6K224
CA$139.89$105.6M755.0K5.3K
MI$139.22$50.6M363.1K2.7K
RI$139.20$6.0M43.2K284
GU$138.04$258.1K1.9K17
PA$137.37$65.5M476.5K3.2K
WA$137.36$17.1M124.4K1.0K
NV$135.95$8.8M64.4K495
OH$135.38$51.4M379.5K2.7K
LA$135.16$18.8M139.1K1.1K
AE$134.66$157.0K1.2K9
CO$134.58$14.1M104.7K1.0K
GA$134.42$29.7M220.6K1.7K
NM$134.34$5.9M43.7K406
TX$134.20$71.0M529.1K4.3K
VA$134.07$31.7M236.7K1.6K
NH$133.72$5.1M38.1K302
ME$133.68$4.3M31.8K340
ZZ$133.55$122.9K9207
MT$133.54$3.4M25.7K154
AZ$133.23$20.6M154.8K1.2K
ND$133.21$2.6M19.1K113
WV$133.14$6.5M49.1K421
MO$133.04$21.7M163.3K1.2K
OR$132.39$9.4M70.9K683
SC$131.56$22.8M173.0K1.1K
MS$131.33$12.8M97.1K547
KY$131.17$19.0M145.2K1.0K
UT$131.12$5.8M44.3K457
HI$130.95$2.8M21.2K192
VT$130.64$2.1M16.0K129
NC$130.36$37.3M286.3K2.2K
OK$129.36$16.5M127.8K786
MN$129.30$15.9M122.9K1.2K
TN$129.24$23.7M183.0K1.3K
SD$129.16$2.7M21.2K134
AL$128.87$14.0M108.3K827
IN$128.85$25.6M198.3K1.4K
WY$128.45$1.7M13.5K92

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Ruslan IvanovFamily PracticeFL$178.2K1.3K$142.19
Theresa GandorEmergency MedicineIL$164.8K1.0K$158.15
Daniel MontgomeryEmergency MedicineSD$150.5K1.1K$136.46
Matthew LeonardEmergency MedicineNC$149.0K952$156.56
Todd TemplemanEmergency MedicineDC$148.6K929$159.92
Juan AcostaEmergency MedicineNY$143.1K841$170.13
Nicole NembhardEmergency MedicineNY$140.2K816$171.83
Kenneth MclaughlinEmergency MedicineMA$139.5K974$143.19
Imraan HaniffEmergency MedicineOH$139.4K1.0K$136.65
James AronEmergency MedicineMS$139.1K1.1K$132.23
James ArnoldEmergency MedicineAR$139.1K1.1K$129.01
David RomanelliEmergency MedicineNY$136.6K839$162.85
Shannon ReeveEmergency MedicineMD$136.3K858$158.84
Sayed KhwajaEmergency MedicineNY$136.2K803$169.65
Nicole PomerantzEmergency MedicineMI$135.5K927$146.22
Cindy LiEmergency MedicineNY$133.6K791$168.93
Gerald StellFamily PracticeLA$133.5K968$137.94
Khoi LamEmergency MedicineCA$133.4K907$147.05
Frank TresgalloEmergency MedicineFL$132.3K878$150.69
Daniel DawsonEmergency MedicineAZ$132.2K966$136.82

🤔 Is Emergency department visit, problem with significant threat to life or function Overpriced?

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.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.