How much does Medicare pay for CPT 99281?

Medicare allowed an average of $10.47 per service and paid $7.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $108.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99281?

Emergency department visit for problem that may not require health care professional. It was billed 1,146 times to 1,091 Medicare beneficiaries by 59 providers in 2024.

Does 99281 pay differently in an office than a hospital?

Yes. The allowed amount averaged $10.85 in an office setting and $10.46 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99281 most?

Physician Assistant, with 385 services from 15 clinicians. Next are Nurse Practitioner, Emergency Medicine, Family Practice.

CPT 99281

Emergency department visit for problem that may not require health care professional

$10.47Medicare-allowed amount per service, averaged across 1,146 services

Providers submitted

$108.25

Asking price, not received

Medicare allowed

$10.47

The fee schedule figure

Medicare paid

$7.60

Balance is patient coinsurance

Providers submitted an average of $108.25 for this code and Medicare allowed $10.47 — 10.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $7.60 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $10.85
Hospital / facility: $10.46

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 11 services were billed in an office setting and 1,135 in a facility.

Services: 1,146
Beneficiaries: 1,091
Providers billing it: 59
Total allowed: $11,999

What Medicare pays for CPT 99281

Across 1,146 services billed by 59 providers to 1,091 beneficiaries, Medicare allowed an average of $10.47 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99281

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physician Assistant	385	380	$10.16	15
Nurse Practitioner	192	175	$9.87	12
Emergency Medicine	150	134	$10.87	9
Family Practice	98	96	$10.67	6
Neurology	70	70	$10.42	4
Neurosurgery	57	57	$11.99	2
General Surgery	54	54	$10.71	3
Psychiatry	39	34	$10.80	2
Internal Medicine	39	36	$10.95	2
General Practice	19	12	$11.13	1
Vascular Surgery	17	17	$11.18	1
Orthopedic Surgery	15	15	$10.99	1
Cardiology	11	11	$9.65	1

99281 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	220	$10.63	$7.36	10
Maryland	170	$10.88	$7.51	5
Arkansas	113	$10.38	$7.93	6
North Carolina	109	$9.90	$7.74	5
California	90	$11.13	$7.94	5
Florida	83	$10.05	$7.42	6
Louisiana	54	$9.54	$7.07	3
Minnesota	38	$10.80	$8.42	2
Mississippi	37	$10.22	$6.04	2
Massachusetts	37	$10.33	$6.83	3
Kansas	29	$9.88	$6.23	2
Illinois	25	$11.04	$7.61	2
Missouri	25	$9.38	$7.04	1
Hawaii	25	$10.46	$7.86	1
U.S. Virgin Islands	19	$10.54	$7.97	1
Puerto Rico	19	$11.13	$7.47	1
New Jersey	18	$10.12	$7.46	1
Guam	13	$11.00	$7.50	1
Oklahoma	11	$10.77	$7.34	1
Georgia	11	$10.98	$6.45	1

Related codes

99214Established patient office or other outpatient visit$117.48
99213Established patient office or other outpatient visit$83.92
99232Subsequent hospital care$76.07
99233Subsequent hospital care$115.58
99215Established patient office or other outpatient visit$163.65
99204New patient office or other outpatient visit$157.90
99223Initial hospital care$167.67
99285Emergency department visit$169.68
99203New patient office or other outpatient visit$104.03
99212Established patient office or other outpatient visit$52.42
99291Critical care$208.35
99222Initial hospital care$126.29

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.