Emergency Room Billing Services

Emergency department billing involves high-acuity coding, critical care time capture, observation services, and the interplay between facility and professional fee billing. No Surprises Act compliance adds another layer.

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300+ Practices

99281Low ED Visit

99285High ED Visit

99291Critical Care

NSACompliant

Why Emergency Room Billing Requires Specialty Expertise

ED billing uses the 99281-99285 code range with different documentation requirements than office-based E/M. Critical care (99291-99292) is time-based. Observation services have specific admission criteria. The No Surprises Act affects OON emergency billing.

Common Emergency Room CPT Codes

Our coders handle these emergency room codes daily. This is not an exhaustive list.

Code

Description

99281

Emergency department visit, minor problem

99282

Emergency department visit, straightforward MDM

99283

Emergency department visit, low MDM

99284

Emergency department visit, moderate MDM

99285

Emergency department visit, high MDM

99291

Critical care, first 30-74 minutes

99292

Critical care, each additional 30 minutes

36556

Central venous catheter insertion (age 5+)

31500

Endotracheal intubation, emergency

92950

Cardiopulmonary resuscitation

2026 Medicare Allowables for Emergency Room CPT Codes by State

Medicare reimbursement for emergency roomprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same emergency room CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 10 core emergency roomcodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.

Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.

2026 Medicare non-facility allowable for Emergency Room CPT codes across high-volume states
Code	Emergency Room Procedure	CA	TX	FL	NY	PA	IL	OH	GA	NC	MI
99281	Emergency department visit, minor problem	$11.17	$10.97	$11.97	$11.97	$11.13	$11.91	$10.89	$11.15	$10.55	$11.33
99282	Emergency department visit, straightforward MDM	$40.89	$40.24	$43.91	$43.86	$40.84	$43.68	$39.95	$40.92	$38.71	$41.57
99283	Emergency department visit, low MDM	$70.04	$69.15	$75.83	$75.49	$70.22	$75.43	$68.71	$70.44	$66.44	$71.62
99284	Emergency department visit, moderate MDM	$118.92	$117.68	$129.36	$128.52	$119.56	$128.70	$117.03	$119.98	$113.01	$122.09
99285	Emergency department visit, high MDM	$172.77	$170.60	$186.60	$185.95	$173.21	$185.69	$169.59	$173.70	$164.10	$176.56
99291	Critical care, first 30-74 minutes	$333.57	$306.47	$323.98	$338.17	$308.43	$318.64	$296.62	$305.61	$293.81	$306.48
99292	Critical care, each additional 30 minutes	$142.48	$133.01	$141.38	$146.17	$134.09	$139.47	$129.55	$133.20	$127.74	$133.95
36556	Central venous catheter insertion (age 5+)	$268.06	$234.90	$245.66	$263.28	$235.31	$239.18	$222.82	$231.45	$223.45	$230.39
31500	Endotracheal intubation, emergency	$132.59	$132.04	$148.18	$145.54	$134.53	$147.24	$131.41	$135.36	$125.87	$138.31
92950	Cardiopulmonary resuscitation	$419.95	$375.14	$393.79	$417.63	$376.49	$385.04	$358.85	$371.41	$358.11	$370.81

Full Emergency Room fee detail by state

State:

2026 Medicare allowables for emergency room CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.

2026 Medicare allowables for Emergency Room CPT codes in California
Code	Description	Non-Facility	Facility
99281	Emergency department visit, minor problem	$11.17	$11.17
99282	Emergency department visit, straightforward MDM	$40.89	$40.89
99283	Emergency department visit, low MDM	$70.04	$70.04
99284	Emergency department visit, moderate MDM	$118.92	$118.92
99285	Emergency department visit, high MDM	$172.77	$172.77
99291	Critical care, first 30-74 minutes	$333.57	$203.54
99292	Critical care, each additional 30 minutes	$142.48	$102.56
36556	Central venous catheter insertion (age 5+)	$268.06	$78.34
31500	Endotracheal intubation, emergency	$132.59	$132.59
92950	Cardiopulmonary resuscitation	$419.95	$172.94

Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.

Emergency Room Billing Challenges We Solve

Common billing problems in emergency room and how our team handles them.

ED E/M Level Selection

99281-99285 has facility-specific documentation guidelines different from outpatient E/M.

Critical Care Time

99291 requires 30+ min of documented critical care time. Every additional 30 min adds 99292.

Observation Services

Admission criteria, time tracking, and conversion to inpatient have specific rules.

No Surprises Act

OON emergency services have federal billing protections and IDR requirements.

Common Emergency Room Denial Reasons

We prevent these before submission and appeal aggressively when they occur.

99281-99285 has facility-specific documentation guidelines different from outpatient E/M

99291 requires 30+ min of documented critical care time

Admission criteria, time tracking, and conversion to inpatient have specific rules

OON emergency services have federal billing protections and IDR requirements

Revenue Opportunities Most Emergency Room Practices Miss

Emergency department practices lose the most revenue from critical care time under-documentation. When a physician spends 74 minutes on critical care for a trauma patient, that's 99291 + 99292 — two codes instead of one. But if the documentation says only 'patient required critical care management' without specifying total time and activities, only one unit of 99291 can be supported. Proper critical care documentation can add $100,000+ annually for a busy ED group. Procedure capture is the second area. ED physicians perform laceration repairs, fracture care, abscess drainage, and other procedures that should be billed separately from the E/M code with proper documentation.

Payer-Specific Emergency Room Billing Tips

ED billing intersects with the No Surprises Act for OON emergency services. Under the NSA, OON ED physicians cannot balance bill patients for emergency services. Payment disputes go through the IDR process. We handle NSA compliance and IDR submissions. Medicare and commercial payers apply different E/M guidelines for ED visits. Medicare uses the standard 99281-99285 guidelines, while some commercial payers (especially managed Medicaid) may require their own documentation templates. We code to each payer's specific ED E/M requirements.

Emergency Room Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

ED E/M levels (99281-99285) can be assigned based on facility-specific acuity tools or CMS documentation guidelines — verify which method your facility and payers accept.

Critical care (99291) requires 30+ minutes of direct bedside critical care time documented with activities performed. Time spent on separately billable procedures doesn't count toward critical care time.

Observation services (99218-99220, 99234-99236) have specific admission and discharge coding depending on whether the observation spans calendar dates.

Document the medical screening exam (MSE) for every ED patient — this is required under EMTALA and supports the E/M level.

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What We Handle for Emergency Room Practices

ED E/M coding (99281-99285)

Critical care time capture

Observation services billing

Facility and professional fee billing

No Surprises Act compliance

Trauma activation coding

Why Choose Go Medical Billing for Emergency Room

Our ER coding team handles the full spectrum from low-acuity visits to critical care, with correct time documentation and NSA compliance.

We serve emergency room practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.

Emergency Room Billing by State

We handle emergency room billing in all 50 states. The 2026 Medicare allowables for emergency room CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.

California Texas Florida New York Pennsylvania Illinois Ohio Georgia North Carolina Michigan New Jersey Virginia Massachusetts Arizona Tennessee Maryland Indiana Missouri Wisconsin Colorado

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Related Resources

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Frequently Asked Questions

We document and code critical care time (99291 for first 30+ min, 99292 for each additional 30 min) with supporting documentation.

Yes. We handle OON emergency billing, patient cost-sharing, and IDR submissions per federal requirements.

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Stop losing revenue to emergency room coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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