CPT 99282 cost and Medicare rate
For code 99282, emergency department visit with straightforward medical decision making, Medicare's 2026 national rate for the hospital's facility fee is about $157, and its rate for the doctor's part nationally is about $40, so about $197 in all. In 2024, doctors nationally typically billed about $251 for their part. The hospital and the doctor usually send separate bills. Medicare rates are a common benchmark, not what every plan pays.
What CPT 99282 is
Emergency department visit with straightforward medical decision making.
What Medicare pays for 99282 nationally
| Setting | Medicare 2026 | Medicare allowed 2024 | Typically billed 2024 |
|---|---|---|---|
| Hospital or surgery center (doctor's part) | $40.42 | $39.16 | $251.43 |
Medicare 2026 is the national fee schedule rate (conversion factor 33.4009). "Medicare allowed" and "typically billed" are averages from Medicare claims in 2024.
If it was done in a hospital
Medicare's national hospital outpatient (OPPS) rate for the hospital's own facility fee, before each hospital's local wage adjustment, which raises it in high-cost areas and lowers it in low-cost ones. The doctor bills separately under the fee schedule.
Medicare's July 2026 national rate for the hospital's facility fee for 99282 is $156.87 (payment group APC 5022).
If the visit became an observation stay
Only when the visit led to a hospital observation stay, which is billed as one larger bundle. In the CMS Outpatient Hospitals data, the Comprehensive Observation Services bundle had a typical hospital charge of $25,290.26 and a Medicare allowed amount of $2,796.47 (536 stays).
99282 by state
Where you were treated changes the benchmark. Medicare's 2026 rate depends on the pricing area. The table shows the rest-of-state rate and the range across each state's pricing areas; some big cities have their own, higher rate. Billed amounts are what providers typically billed in a hospital or other facility in 2024.
| State and Medicare pricing area | Doctor's part 2026 | Range in state (doctor's part) | Typically billed 2024 |
|---|---|---|---|
| California Rest of California | $39.78 | $39.78 to $44.64 29 pricing areas | $270.62 |
| New York Rest of New York | $39.04 | $39.04 to $46.62 5 pricing areas | $234.22 |
| Texas Rest of Texas | $39.77 | $39.64 to $42.01 8 pricing areas | $327.79 |
| Florida Rest of Florida | $42.01 | $42.01 to $46.27 3 pricing areas | $343.47 |
| Illinois Rest of Illinois | $41.99 | $41.99 to $45.42 4 pricing areas | $244.03 |
| Ohio Statewide | $39.95 | One rate statewide | $266.21 |
| Georgia Rest of Georgia | $40.51 | $40.51 to $41.34 2 pricing areas | $318.88 |
| Washington Rest of Washington | $40.24 | $40.24 to $42.58 2 pricing areas | $236.29 |
| Pennsylvania Rest of Pennsylvania | $39.75 | $39.75 to $41.92 2 pricing areas | $276.14 |
| Arizona Statewide | $39.71 | One rate statewide | $249.22 |
What your charge for 99282 means
Med Bill Check compares a charge with Medicare's rate and with what providers typically billed. Here is how it reads three national charges, each compared with the hospital facility fee plus doctor's fee:
- Charged $200: Your $200 is close to what Medicare would pay the hospital and the doctor together, which is a good sign. If it is only the hospital's charge, it is about 1.3 times the hospital's rate. Medicare rates are a common benchmark, not what every plan pays.
- Charged $390: Your $390 is about 2 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 2.5 times the hospital's rate. Medicare rates are a common benchmark, not what every plan pays.
- Charged $790: Your $790 is about 4 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 5 times the hospital's rate. That is a common benchmark rather than a verdict, and an itemized bill will show which charges are the hospital's and which are the doctor's.
Medicare rates are a common benchmark, not what every plan or provider charges, and never proof a bill is wrong. Enter your own charge and state on the home page for your figures.
Common billing questions for 99282
- Units: Medicare's automated limit for 99282 is 2 units for one patient on one day (NCCI Medically Unlikely Edits). If your bill shows more, ask them to confirm the units. Medicare limits (MUE) are the most units Medicare pays automatically for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
- Duplicates and services you did not get: Look for duplicate lines, services you did not receive, and unit counts that look high.
- Two bills: The hospital and the doctor usually send separate bills. Check which one each charge is on before comparing it with a rate.
How to question a charge for 99282
- Ask for an itemized bill with codes, units and prices. Itemized bill letter.
- Compare each line with your Explanation of Benefits if you have insurance.
- Ask the billing office to review the charge in writing, and to hold the account from collections meanwhile. Charge review letter.
- Ask for a prompt-pay or self-pay discount, or an interest-free payment plan. Discount letter.
- If it was a hospital, ask for its financial assistance policy. Financial assistance letter and which hospitals must offer it.
With your code and amount, the review letter adds the benchmark for you, for example: For reference, Medicare's 2026 national hospital outpatient rate for code 99282 is about $157 for the hospital's facility fee, and its 2026 fee schedule rate for the doctor's part nationally is about $40, about $197 together.
Keep a copy of everything you send, and note the date and the name of anyone you speak to. If you have insurance, call your insurer too. They can check whether the claim was processed correctly.
Quick answers
- What is CPT 99282?
- Emergency department visit with straightforward medical decision making.
- How much does Medicare pay for 99282 in 2026?
- Nationally, Medicare's 2026 rate is $156.87 for the hospital's facility fee and $40.42 for the doctor's part. The hospital and the doctor usually send separate bills.
- What do providers typically charge for 99282?
- In 2024, providers nationally typically billed $251.43 for 99282 in a hospital or other facility.
- Is $790 for 99282 too much?
- Your $790 is about 4 times what Medicare would pay the hospital and the doctor together. If it is only the hospital's charge, it is about 5 times the hospital's rate. That is a common benchmark rather than a verdict, and an itemized bill will show which charges are the hospital's and which are the doctor's.
- How much is 99282 in Texas?
- For code 99282, emergency department visit with straightforward medical decision making, Medicare's 2026 national rate for the hospital's facility fee is about $157, and its rate for the doctor's part in Texas is about $40, so about $197 in all. In 2024, doctors in Texas typically billed about $328 for their part. The hospital and the doctor usually send separate bills. Medicare rates are a common benchmark, not what every plan pays.
- How many units of 99282 can be billed in one day?
- Medicare's automated limit is 2 for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
Sources
- CMS Medicare Physician Fee Schedule, 2026 (pfs.data.cms.gov)
- CMS Hospital Outpatient Prospective Payment System (OPPS) Addendum B, July 2026 (cms.gov), national unadjusted payment rates
- CMS Medicare Physician and Other Practitioners by Geography and Service, 2024 data (data.cms.gov)
- CMS NCCI Medically Unlikely Edits, effective 2026-10-01
General information, not medical, legal or financial advice. Medicare rates are a common benchmark, not what every plan or provider charges. For your own bill, check with the billing office, your insurer or your doctor.
Ask Med Bill Check yourself
Enter the code or the service in plain words, your state and what you were charged, and see how it compares with Medicare's rate. Open Med Bill Check, free, no sign-up.
In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/medbillcheck/mcp and ask: “Is $390 for 99282 in Texas too much?”
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