CPT 99283: emergency department visit, low decision making
99283 reports an emergency department visit that needs a medically appropriate history or exam and low medical decision making. It is the middle of the five ED levels and the one most often billed with a procedure, which brings modifier 25 into play.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99283 matches low MDM: a low-complexity problem, limited data and low risk. The professional level comes from the physician's decision making and the hospital's facility level comes from its own resource guidelines, so the two do not have to match.
What does CPT 99283 report?
The AMA descriptor, in plain words, is an emergency department visit for a patient, needing a medically appropriate history or exam and low medical decision making. CMS prints its label as "Emergency dept visit low mdm".
| Item | Value in RVU26D (October 2026) |
|---|---|
| Payment status | A (active code) |
| Work RVU | 1.60 |
| Facility total RVU | 2.08 |
| Non-facility practice expense | Marked NA, meaning rarely or never performed in the non-facility setting |
| Global period | XXX |
What does low MDM look like in the ED?
ACEP's FAQ maps 99283 to a low-complexity problem, limited data and low risk. The chart needs to meet the tier on the elements as the AMA guidelines score them, and CMS Chapter 12 section 30.6.1 says the volume of documentation should not be the main influence on the level.
| MDM element | Tier for 99283 | Typical ED reading, per ACEP |
|---|---|---|
| Problems addressed | Low: two or more minor problems, or one acute uncomplicated illness or injury | A localized complaint with no added signs or symptoms; a minor injury managed without x-rays |
| Data reviewed | Limited: two items such as tests ordered or reviewed, or an independent historian | Two unique tests, each counted once, or an outside note plus one test |
| Risk of management | Low | The AMA table lists no published examples of low risk; ACEP says so directly |
ACEP also says prescription-strength medication or imaging usually pushes a presentation past uncomplicated, so a visit that needed x-rays and a prescription often belongs at 99284 instead.
A patient has a two-centimeter forehead cut after a fall at home, no loss of consciousness, no other complaints. The physician examines, orders no tests, closes the wound and gives home instructions. One uncomplicated injury, no data, low risk: 99283 for the E/M plus the repair code, with modifier 25 on the E/M if the E/M is separate.
How does 99283 appear with a procedure and on both claims?
Professional claim: Item 24B place of service 23, Item 24D 99283 with modifier 25, Item 24G 1. Chapter 12 section 30.6.6 B says modifier 25 goes on the E/M code only when the same physician provides a significant, separately identifiable E/M service above the usual work of the procedure, and that a different diagnosis is not required.
The same section says MACs may not allow modifier 25 to generate payment for multiple E/M services on the same day by the same physician. Adding 25 to repair a wound does not make a second visit payable.
Facility claim: Chapter 4 section 180.2 includes a worked UB-04 example. It shows revenue code 0450 with HCPCS 99283 and modifier 25 on one line, a laceration repair under 12011 on its own 0450 line, and supply and pharmacy charges under other revenue codes. CMS has required separate charges for the ER visit and for procedures since July 1, 2001.
Section 160 says each hospital applies its internal guidelines, which should relate the intensity of hospital resources to the five levels. So the facility 99283 can differ from the physician's 99283, and neither level has to match the other. A Type B emergency department uses G0382, level 3, instead, per the October 2026 HCPCS file.
The NCCI MUE for 99283 effective October 1, 2026 is 1 for practitioners and 2 for outpatient hospital, indicator 3.
Who else bills when more than one clinician sees the ED patient?
Section 30.6.11 F says that when the ED physician asks another physician to evaluate a patient, the other physician bills an emergency department visit code. If that second physician admits the patient, they bill an initial hospital care code and not an ED visit.
Section 30.6.18 allows a split or shared visit in the ED when a physician and a nonphysician practitioner in the same group each do part of one visit. The emergency department row of the CMS table sets the billing practitioner as the one who spends more than half of the total time or performs a substantive part of the MDM. Modifier FS must be reported on the claim to identify it. Only distinct time counts: when both practitioners meet with or discuss the patient together, one practitioner's time is counted.
A nurse practitioner sees a patient with a forehead laceration, and the group physician reviews the history and decides the closure approach. The physician performs the substantive part of the MDM, so the visit is billed under the physician with 99283 and FS. The repair is a separate procedure line with modifier 25 on the E/M if it is separately identifiable.
Why is 99283 denied?
| Code | What X12 says | What usually causes it on 99283 |
|---|---|---|
| CO-4 | The procedure code is inconsistent with the modifier used | Modifier 25 on an E/M line the payer does not treat as having a same-day procedure |
| CO-97 | Benefit is included in the payment for another service already adjudicated | E/M bundled into the procedure because 25 was left off |
| CO-150 | Payer deems the information does not support this level of service | Note lists the complaint but not the data or risk work |
| CO-16 | Claim lacks information or has a submission error | Procedure line missing or the diagnosis pointer is blank |
If these denials keep coming back, our denial management team can work them. See also 99282 below it and 99284 above it.
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
- HCPCS quarterly update, October 2026 alpha-numeric file · CMS
- 2023 ED E/M guidelines FAQs (ACEP Coding and Nomenclature Advisory Committee) · American College of Emergency Physicians
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.
01Does the professional ED level have to match the facility ED level?
No. The physician level comes from the MDM in the chart. CMS Chapter 4 section 160 tells hospitals to apply their own internal guidelines relating hospital resources to the five levels. The two claims can differ for the same visit, and neither is wrong by itself.
02Can I bill 99283 with a laceration repair?
Yes, when the E/M is significant and separately identifiable beyond the usual work of the repair. Append modifier 25 to 99283. Chapter 12 section 30.6.6 B says a different diagnosis is not required. If only the repair was needed, bill the repair alone.
03What does low MDM require in the ED?
A low-complexity problem, limited data and low risk, as ACEP maps the AMA table. ED time does not set the level. History and exam must fit the descriptor but do not set the level. See the MDM section above for examples.
04What is the facility code for a Type B emergency department at level 3?
G0382, listed in the October 2026 HCPCS file as the level 3 hospital emergency department visit provided in a type B emergency department. Chapter 4 section 160 says hospitals bill Type B visits with these G-codes instead of CPT ED codes.
05What is the unit limit on 99283?
The NCCI MUE effective October 1, 2026 is 1 per date for practitioners and 2 for outpatient hospital services, adjudication indicator 3. Modifier 25 does not make a second E/M on the same day by the same physician payable, so do not split one visit across lines.
Procedure visits getting bundled?
We check modifier 25 support on ED visits before the claim goes out.