CPT 99285 cost: what a level 5 ER visit costs in 2026
Real 2026 list and cash prices for a level 5 emergency visit (CPT 99285) at four hospitals, compared with Medicare's $608.43, plus how to check whether level 5 was justified.
What CPT 99285 means
99285 is the highest of five emergency department visit levels. It's meant for visits that need a high level of medical decision-making, such as a possible heart attack, stroke, or serious injury. The hospital bills a facility charge under this code, and the ER doctor usually bills their own 99285 separately.
What four hospitals list for it in 2026
From each hospital's own federally required price file (method and sources):
• NYU Langone Tisch: $4,428.08 list, $841.33 cash (7.3x Medicare list)
• Duke University Hospital: $3,556 list, $960.12 cash (5.8x)
• UCHealth Yampa Valley: $3,509 list, $3,158.10 cash (5.8x)
• OHSU Hospital: $3,156 list, $2,051.40 cash (5.2x)
Medicare's 2026 national hospital outpatient (OPPS) payment for 99285 is $608.43. These are list and cash prices, not what insurers pay.
Level 5 vs level 4 vs level 3
Medicare's 2026 OPPS payments step up by level: 99283 $278.89, 99284 $426.30, 99285 $608.43. Dropping one level on a disputed bill moves the Medicare benchmark by about $182. At the four hospitals, list prices for 99284 ran $2,065–$3,738.94, so a level that's one step too high can add over $1,000 to a list-price bill.
How to check whether level 5 was justified
Request your itemized bill and the ER record (the ED physician note). Level 5 should match what happened: serious symptoms, multiple tests or imaging, IV drugs, or consultation with specialists. If you were seen briefly, given a prescription, and sent home, ask the hospital in writing to explain how the visit met level 5 criteria. Ask for a coding review.
What to put in a dispute
Name the line (date, CPT 99285, amount), state that the documented care doesn't support the highest level, and ask for a coding review and a corrected bill. Mention that Medicare pays $608.43 for this facility level in 2026 as a reference point. You can see the 99285 benchmark or scan your bill to draft the letter.
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How much does a level 5 ER visit cost?
At four hospitals we studied, the 2026 list price for the facility charge was $3,156–$4,428. Medicare pays $608.43. The doctor's fee is billed separately.
Can I dispute a level 5 ER charge?
Yes. Ask for a coding review if your records don't show high-complexity care. The hospital may lower the level, keep it, or explain it.
Is 99285 the doctor or the hospital charge?
Both can use 99285. The hospital bills a facility charge and the ER physician bills a professional fee under the same code.
Educational information, not legal advice. Laws and deadlines change, so verify with official sources. More guides: How to dispute a medical bill · How to request an itemized medical bill (free letter template) · No Surprises Act dispute · Medical billing error checklist · Hospital charity care · ER bill too high? What to check and how to fight it · BillRebuttal vs. hiring a medical bill advocate · BillRebuttal vs. Dollar For · Hospital facility fees explained · How much do stitches cost at the ER? 2026 hospital price data · How much does a CT scan cost at the hospital? 2026 price file data · Hospital cash price vs list price