Reimbursement
$40.75
Threshold
N/A
2026 Status
Active
What is CPT Code 99282?
CPT 99282 is defined as: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level medical decision making. Typically involves stable patients with self-limited or minor problems.
This code is primarily used for E/M services. It falls under the category of Hospital Inpatient/Observation & Emergency Department and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.93
Physician Effort
PE (Non-Fac)
0.21
Practice Expense
Malpractice
0.08
Risk Factor
Total RVU
1.22
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
em intensity
wRVU of 0.93 captures the specialized high-intensity environment of the ED relative to standard office visits.
efficiency shield
Exempt from -2.5% efficiency cut.
facility differential
Payment is scaled based on facility-level resource allocation.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
Not time-based in the ED; based on MDM
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Per encounter
add on codes
care plan requirement
Low complexity medical decision making; assessment of stable acute problems.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
CMS is focusing on 'Medical Necessity for the Site of Service' - ensure the ED stay is justified by the clinical presentation.
Common Clinical Scenarios
CMS Eligibility: 1 self-limited or minor problem. Acute
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99281
99281 is straightforward (clinical staff); 99282 is low MDM (requires MD/QHP).
VS 99283
99283 is moderate MDM.
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