Emergency Medicine CPT Codes
ED billing has its own E&M family, 99281 through 99285, and one rule that surprises everyone trained on office codes: time doesn't count. ED levels are selected purely on medical decision making, because emergency care doesn't run on appointment clocks. Above the levels sits critical care, which is time-based, creating the specialty's central coding decision.
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Emergency Medicine CPT codes
ED Visit, Moderate MDM
The middle ED level: moderate severity problems, moderate decision making.
ED Visit, Moderate-High MDM
Higher-acuity visits requiring urgent evaluation.
ED Visit, High MDM
The highest ED level: severe problems with high-complexity decision making.
Critical Care, First 30–74 Minutes
Time-based critical care for life-threatening conditions. Requires documented total time.
Critical Care, Each Additional 30 Minutes (Add-on)
Additional critical care time beyond 74 minutes.
Simple Wound Repair, Scalp/Trunk/Extremities, ≤2.5 cm
Simple single-layer laceration repair. The repair family ladders by length, depth, and site.
Codes in blue have full detail pages with documentation requirements, billing mistakes, and FAQ.
Emergency Medicine billing notes
ED E&M levels (99281–99285) are chosen by medical decision making only. Total time is irrelevant, unlike office E&M. There's also no new-versus-established distinction in the ED.
Critical care starts when a patient has a life-threatening condition requiring the physician's full attention: 99291 covers the first 30 to 74 minutes, and 99292 adds each additional 30. Under 30 minutes of critical care, bill the highest ED level instead.
Time spent on separately billable procedures doesn't count toward critical care time. Run the clock on the critical care, pause it for the intubation you're billing separately.
Procedures in the ED, like laceration repair, bill alongside the E&M with modifier 25 on the visit when the evaluation was significant and separate.
Laceration repair codes ladder by complexity (simple, intermediate, complex), body area, and total length. Multiple wounds in the same class and area sum their lengths into one code.
Frequently asked questions about emergency medicine billing
Why doesn't time matter for ED visit levels?▼
Because the ED E&M codes were built for an environment where physicians juggle multiple patients without appointments. The 2023 guidelines kept ED levels on medical decision making alone. The one place time rules in the ED is critical care, where 99291 requires at least 30 documented minutes.
When do I bill critical care instead of 99285?▼
When the patient has a condition with a high probability of imminent deterioration and the physician's documented critical care time reaches 30 minutes. Both the clinical severity and the time have to be there. High acuity without 30 minutes of critical care time stays at 99285.
Can I bill an ED visit and a laceration repair together?▼
Yes, when the evaluation was significant and separate from the repair, which in the ED it usually is. Append modifier 25 to the E&M code. What you can't do is count the repair time or work toward the E&M level; the procedure pays for itself.
Sources
- Code set structure and updates: American Medical Association — CPT
- Fee schedule and component billing rules: CMS Medicare Physician Fee Schedule
- How we research and verify: our editorial policy
CPT® is a registered trademark of the American Medical Association. Content on this page is original educational writing, not a reproduction of AMA-copyrighted descriptions. Verify codes and payer rules before billing.