99285
Emergency dept visit, high/urgent complexity
Emergency dept visit, high/urgent complexity is the #11 most-billed Medicaid procedure code, with $15.10B in payments across 111.0M claims from 2018–2024. The national median cost per claim is $85.65. Costs vary widely — the 90th percentile is $209.58 per claim, 2.4× the median.
Total Paid
$15.10B
1.38% of all spending
Total Claims
111.0M
Providers
18K
Avg Cost/Claim
$136
National Cost Distribution
How much do providers bill per claim for 99285? Based on 18K providers billing this code nationally.
Median
$85.65
Average
$112.54
Std Dev
$117.69
Max
$2,320.50
Percentile Distribution (Cost per Claim)
50% of providers bill between $55.96 and $124.53 per claim for this code.
90% bill between $33.87 and $209.58.
Top 1% bill above $562.04.
About This Procedure
HCPCS code 99285 (Emergency dept visit, high/urgent complexity) was billed by 18K providers across 111.0M claims, totaling $15.10B in Medicaid payments from 2018–2024. This code was used for 99.8M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$85.65
Providers Billing
18K
National Spending
$15.10B
Avg/Median Ratio
1.31×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99285
| # | Provider | Total Paid |
|---|---|---|
| 1 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $112.7M |
| 2 | Southeastern Emergency Physicians Llc Maysville, KY · Emergency Medicine, Pediatric Emergency Medicine | $90.7M |
| 3 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $88.1M |
| 4 | Texas Children's Hospital Houston, TX · General Acute Care Hospital Children | $80.5M |
| 5 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $68.0M |
| 6 | Henry Ford Health System Detroit, MI · General Acute Care Hospital | $62.1M |
| 7 | Presbyterian Healthcare Services Albuquerque, NM · Emergency Medicine | $56.4M |
| 8 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $55.0M |
| 9 | Emergency Coverage, Llc Newport, TN · Emergency Medicine | $54.1M |
| 10 | Bakersfield Memorial Hospital Bakersfield, CA · General Acute Care Hospital | $51.6M |
| 11 | Cook Children's Medical Center Fort Worth, TX · General Acute Care Hospital Children | $51.2M |
| 12 | 1184795874 | $50.6M |
| 13 | Saint Francis Hospital And Medical Center Hartford, CT · General Acute Care Hospital | $50.3M |
| 14 | Hennepin Healthcare System Inc Minneapolis, MN · General Acute Care Hospital | $49.6M |
| 15 | Banner Desert Medical Center Mesa, AZ · General Acute Care Hospital | $46.6M |
| 16 | Egleston Children's Hospital At Emory University Inc. Atlanta, GA · Pediatrics Pediatric Emergency Medicine | $45.5M |
| 17 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $45.3M |
| 18 | Bridgeport Hospital Bridgeport, CT · General Acute Care Hospital | $45.3M |
| 19 | North Shore-lij Medical Pc Great Neck, NY · Urology | $44.5M |
| 20 | Mep Health Llc Rockville, MD · Emergency Medicine | $44.2M |
Showing top 20 of 18K providers billing this code