CPT 99282: Emergency Department Visit, Straightforward Decision Making
99282 reports an emergency department visit that needs a medically appropriate history or exam and straightforward medical decision making. Straightforward is the first MDM tier, so 99282, not 99281, is where decision making starts to be scored.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99282 matches straightforward MDM: a minimal problem, minimal or no data, and minimal risk. Few patients who need the ED fit that profile, so the code is used sparingly and the chart has to show why nothing higher applies.
What Does CPT 99282 Report?
The AMA descriptor, in plain words, is an emergency department visit for a patient, needing a medically appropriate history or exam and straightforward medical decision making. CMS prints its label as "Emergency dept visit sf mdm".
This also answers a common question: straightforward decision making belongs to 99282. It is not 99281, which names no decision making tier.
| Item | Value in RVU26D (October 2026) |
|---|---|
| Payment status | A (active code) |
| Work RVU | 0.93 |
| Facility total RVU | 1.21 |
| Non-facility practice expense | Marked NA, meaning rarely or never performed in the non-facility setting |
| Global period | XXX |
What Does Straightforward MDM Look Like for an ED Visit?
CMS Chapter 12 section 30.6.1 says the level is chosen by MDM and the history and exam do not affect it. ACEP's FAQ maps the three MDM elements for 99282 to a minimal problem, minimal or no data, and minimal risk.
| MDM element | Tier for 99282 | What ACEP says about ED reality |
|---|---|---|
| Problems addressed | Minimal: one self-limited or minor problem | ACEP calls it improbable that many ED patients fit, and expects mostly returns for suture removal, dressing changes or packing removal |
| Data reviewed | Minimal or none | No tests ordered or reviewed to reach this level |
| Risk of management | Minimal | ACEP lists suture or packing removal from a well-healed wound as usually minimal risk |
Because a problem that is not resolving on its expected course counts as an acute uncomplicated illness, per the guideline definition ACEP reprints, a patient who came in worried about something minor can still score above this tier if the chart shows more work.
An asymptomatic employee comes in only for a release note that the employer requires. The physician takes a brief history, examines, and issues the note. ACEP's FAQ describes this as minimal problem and minimal risk, which supports 99282. If the same patient also reports pain that needs evaluation, the level moves up.
How Does 99282 Appear on the Claim?
Professional claim: Item 24D carries 99282, Item 24G carries 1 and Item 24B carries place of service 23 per the CMS place of service set. Chapter 12 section 30.6.11 B says ED codes are for patients actually seen in the emergency department, defined as an organized hospital-based facility for unscheduled or episodic services.
Facility claim: the hospital reports 99282 on the UB-04 under a 045x revenue code. Chapter 4 section 160 tells hospitals to apply their own internal guidelines to the five levels, so the facility level comes from hospital resources, not from the physician's MDM. See hospital and facility billing.
Section 30.6.11 C adds that ED services may be non-emergencies and are still payable if the described service was provided, and that a lower ED level is normally reported for a nonemergency condition. If a physician asks a patient to meet in the ED as an alternative to the office and the patient is not registered there, bill an office visit instead.
The NCCI MUE for 99282 effective October 1, 2026 is 1 for practitioners and 2 for outpatient hospital, both with indicator 3.
Who Can Bill an ED Level When the Patient's Own Physician Comes In?
Section 30.6.11 E covers a physician who tells their own patient to go to the emergency department and is then asked by the ED physician to come in and advise on admission or discharge. The result depends on the outcome. If the personal physician admits, they bill only initial hospital care (99221 to 99223) and the ED physician bills the ED level. If the patient goes home, both bill the ED level that describes their own work. Telephone advice alone is not billable.
The facility claim does not change: the hospital reports one outpatient visit line, and each physician bills on their own CMS-1500 in Item 24D. Facility and professional levels can differ.
A patient with a minor rash is sent to the ED by their physician, who comes in at the ED physician's request, examines the patient and sees them go home. Each physician bills the ED level their own note supports, such as 99282 for a minimal problem.
Why Is 99282 Denied or Paid at a Lower Level?
| Code | What X12 says | What usually causes it on 99282 |
|---|---|---|
| CO-97 | Benefit is included in the payment for another service already adjudicated | A same-day office visit or second E/M from the same group was already paid |
| CO-50 | Non-covered because the payer does not deem it medically necessary | The payer reads the visit as a convenience visit; the note needs the reason for ED care |
| CO-151 | Payer deems the information does not support this many or this frequency of services | Repeated low-level returns for the same issue inside a short window |
| CO-16 | Claim lacks information or has a submission error | Missing diagnosis pointer or place of service |
The more frequent loss on this code is the opposite: a chart that supports more than 99282 but is leveled low because the note lists symptoms without the work. That is lost revenue with no denial code. If these denials keep coming back, our denial management team can work them. Compare with 99281 and 99283.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner and outpatient hospital tables, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
- Place of service code set · CMS
- 2023 ED E/M guidelines FAQs (ACEP Coding and Nomenclature Advisory Committee) · American College of Emergency Physicians
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What counts as straightforward decision making for ED visits?
It is the first MDM tier: one self-limited or minor problem, minimal or no data, and minimal risk of management. In the ED that is a narrow group, such as an uncomplicated return for suture removal. The code for it is 99282, since 99281 has no decision making tier.
02Is 99282 the same as 99281 with a physician?
No. 99281 is for care that may not need the physician present and has no MDM tier. 99282 requires a medically appropriate history or exam plus straightforward MDM, so the decision making must be documented in the chart by the treating clinician.
03Do I need a different diagnosis for each ED visit level?
No. The ED level is set by MDM, and the final diagnosis does not decide complexity on its own. ACEP's FAQ notes that an extensive work-up to rule out a serious condition can support a higher level even when the final diagnosis is minor.
04What place of service is used for 99282?
Place of service 23, Emergency Room, Hospital, for the professional CMS-1500 claim. The hospital reports its own side on the UB-04 with a 045x revenue code, using its internal level guidelines under Chapter 4 section 160 of the CMS manual.
05What is the unit limit for 99282?
The NCCI MUE effective October 1, 2026 is 1 unit per date for practitioner services and 2 for outpatient hospital services, adjudication indicator 3. One ED visit per encounter is the normal pattern, so a second 99282 line on the same date for the same physician is likely to be denied.
Low ED Levels Left Unclear?
We code the ED level from the chart and flag notes that under or over state it.