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Hospital billing of the two most expensive emergency room codes — 99284 and 99285 — jumped while less expensive codes — 99281 through 999283 — dropped off. The billing codes represent the varying levels of hospital resources required for different types of care; the codes call for payments ranging from $50 to $324, and come on top of physician fees. The codes were developed for physicians, not hospitals. Yet Medicare’s administrator has balked at implementing uniform standards governing how hospitals determine which codes to bill. Instead, Medicare relies on hospitals to set their own internal rules.

Emergency Room VisitsHigher-numbered codes receive higher payments from Medicare. Percentage of visits charged at higher-level codes 9928499285‘01‘02‘03‘04‘05‘06‘07‘080%10%20%30%40%
Percentage of visits charged at lower-level codes 992819928299283‘01‘02‘03‘04‘05‘06‘07‘080%10%20%30%40%

Graphic by Timothy Meko

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