99285 Emergency dept visit hi mdm
Also known as: ED visit high complexity, emergency high, ER high severity, ED visit level 5, critical ER visit, ER visit critical, emergency room level 5, trauma activation
Emergency department visit for the evaluation and management of a patient with high medical decision-making complexity.
In Plain Language
Complex emergency room visit; Serious emergency care
Clinical Context
Used for emergency department visits with high medical decision-making complexity, such as critically ill or injured patients, multiple acute significant conditions, or presentations requiring extensive diagnostic and therapeutic evaluation.
RVU Breakdown
| Work RVU | 4.00 |
| Total RVU | 4.00 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 4.00, this code ranks in the 93rd percentile among Evaluation & Management codes — 2.6x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99285?
CPT 99285 (Emergency dept visit hi mdm) is a Evaluation & Management code. Emergency department visit for the evaluation and management of a patient with high medical decision-making complexity.
Who uses CPT code 99285?
CPT 99285 is used by Emergency Medicine, Critical Care. Used for emergency department visits with high medical decision-making complexity, such as critically ill or injured patients, multiple acute significant conditions, or presentations requiring extensive diagnostic and therapeutic evaluation.
When is CPT 99285 used?
Used for emergency department visits with high medical decision-making complexity, such as critically ill or injured patients, multiple acute significant conditions, or presentations requiring extensive diagnostic and therapeutic evaluation.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.