99281
Emergency dept visit, minimal complexity
Emergency dept visit, minimal complexity is the #208 most-billed Medicaid procedure code, with $743.0M in payments across 8.0M claims from 2018–2024. The national median cost per claim is $52.03. Costs vary widely — the 90th percentile is $157.24 per claim, 3.0× the median.
Total Paid
$743.0M
0.07% of all spending
Total Claims
8.0M
Providers
4K
Avg Cost/Claim
$93
National Cost Distribution
How much do providers bill per claim for 99281? Based on 3K providers billing this code nationally.
Median
$52.03
Average
$73.12
Std Dev
$76.38
Max
$1,580.56
Percentile Distribution (Cost per Claim)
50% of providers bill between $20.87 and $106.74 per claim for this code.
90% bill between $11.80 and $157.24.
Top 1% bill above $303.23.
About This Procedure
HCPCS code 99281 (Emergency dept visit, minimal complexity) was billed by 4K providers across 8.0M claims, totaling $743.0M in Medicaid payments from 2018–2024. This code was used for 7.2M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$52.03
Providers Billing
3K
National Spending
$743.0M
Avg/Median Ratio
1.41×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99281
| # | Provider | Total Paid |
|---|---|---|
| 1 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $25.5M |
| 2 | 1518018191 | $19.5M |
| 3 | 1477671535 | $19.0M |
| 4 | 1750384079 | $15.0M |
| 5 | 1063616613 | $12.3M |
| 6 | 1821147786 | $9.9M |
| 7 | Children's Hospital Washington, DC · General Acute Care Hospital Children | $8.4M |
| 8 | 1427181007 | $8.2M |
| 9 | County Of Ventura Ventura, CA · Clinic/Center, Emergency Care | $8.0M |
| 10 | 1952634008 | $7.8M |
| 11 | 1932197258 | $7.0M |
| 12 | 1710958228 | $6.9M |
| 13 | 1366896300 | $6.4M |
| 14 | 1235120676 | $6.0M |
| 15 | Cook Children's Medical Center Fort Worth, TX · General Acute Care Hospital Children | $5.9M |
| 16 | 1366686248 | $5.9M |
| 17 | 1073811378 | $5.6M |
| 18 | 1740413798 | $5.6M |
| 19 | 1205089026 | $5.3M |
| 20 | 1396725677 | $5.3M |
Showing top 20 of 4K providers billing this code