Top billers · Codes · 99285

Who bills 99285?

99285 is the CPT code for: Emergency department visit with high level of medical decision making. In 2024, 64,318 providers billed 99285 8,984,062 times, with an estimated $1.2B paid by Medicare.

$171.35
2026 PFS national rate (facility)
64,318
Providers billing it (2024)
8,984,062
Services billed
$1.2B
Est. Medicare paid
The fee

What does Medicare pay for 99285?

Medicare's 2026 Physician Fee Schedule national rate for 99285 is $171.35 in the facility setting. National amounts before geographic adjustment — your locality's rate differs slightly.

Office (non-facility) rateNo separate office rate
Facility rate$171.35
Fee schedule2026 Medicare Physician Fee Schedule

What Medicare actually paid per service in 2024, on average: $130.82 (observed payment across all settings and modifiers — not a fee-schedule rate).

The list

Who bills 99285 the most.

The top 5 billers nationally, ranked by 2024 Medicare service volume.

#ProviderSpecialtyLocationServicesEst. Medicare paid
1Allen Nau, D.O.Emergency MedicineFreehold, NJ1,210$172K
2George Karroum, M.D.Emergency MedicineLos Angeles, CA1,146$150K
3Ruslan Ivanov, MDFamily PracticeHollywood, FL1,125$151K
4James Arnold, M.D.Emergency MedicineHot Springs, AR1,108$140K
5Jay Mccombs, D.O.Emergency MedicineSun City West, AZ1,078$143K

64,313 more providers billed 99285 in 2024. The full ranked list — filtered to your exact territory, with phone numbers and year-over-year history — is one search in Prospect 811.

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The breakdown

Where 99285 gets billed.

Top states by volume

California847,440 services
Florida667,745 services
Texas569,069 services
New York559,975 services
Pennsylvania496,047 services
Illinois435,285 services
Ohio395,002 services
Michigan370,524 services

About this code

CMS descriptionEmergency department visit with high level of medical decision making
Code typeCPT (Level I HCPCS)
Providers billing it (2024)64,318
Services billed (2024)8,984,062
Avg. Medicare payment per service (2024)$130.82
Where these numbers come from. Rates are CMS's own public fee-schedule files — the Physician Fee Schedule, Clinical Laboratory Fee Schedule, ASP drug pricing, DMEPOS, and the OPPS/ASC addenda — each labeled with its file year on this page; national amounts are shown before geographic adjustment. Codes with no separate rate render the fee schedule's own status in words, never a fake $0. Utilization comes from CMS's public Medicare Provider Utilization & Payment data for 2024, the most recent year released. It covers traditional Medicare fee-for-service only (no commercial insurance, no Medicare Advantage), and CMS suppresses any provider-and-code line with fewer than 11 beneficiaries before publishing, so low-volume billers don't appear at all. "Est. Medicare paid" is each billing line's average Medicare payment times its service count, summed — actual per-claim payment varies by setting and modifiers. For drug and supply codes, a "service" is a billed unit (a milligram, a milliliter, a square centimeter), not a patient visit. Code descriptions are CMS's own, from the utilization files. Prospect 811 organizes public data; it doesn't add to or alter it. Not affiliated with or endorsed by CMS. Full detail on the data page.

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