You went to the ER for a bad cut or a migraine. You were seen, treated and sent home in a few hours. Then the bill came with a line that read “ER Visit – Level 5” and a price in the thousands.
That line may be the most important one on your bill. Here’s what it means and how to tell if it fits your visit.
ER visits are billed in five levels
Every ER visit gets a level from 1 to 5. The code numbers run from 99281 (Level 1) to 99285 (Level 5). A higher level means a higher charge, and the gap between levels can be large.
Since 2023, the doctor’s level has been set by medical decision making. That means how complex your problem was, how much information the doctor had to review, and how risky the treatment decisions were. A Level 5 is supposed to mean high complexity, like a possible heart attack, stroke, serious infection or major injury.
You may be charged a level twice
This is where Series 2 of 4 comes in. You often get two bills for the same visit:
- The doctor’s bill (the professional fee) uses a level based on the doctor’s decision making.
- The hospital’s bill (the facility fee) uses a level based on the hospital’s own rules. These usually count the resources used: nurses, tests, monitoring, medicines.
The two levels don’t have to match, and each one should be checked on its own.
Signs your level may not fit your visit
- You were in and out quickly with one simple problem.
- You had few or no tests, or only a basic X-ray.
- You got a prescription or instructions and were sent home without further workup.
- Your records describe your condition as minor or stable.
- Your level is higher than your symptoms would suggest, and nothing in your records explains why.
A Level 5 isn’t wrong just because you went home. Chest pain that turns out to be heartburn may still justify a big workup. What matters is whether your records support the level.
How to check your level
- Get your itemized bill. It should list the level or the code (99281–99285) for both the facility and the doctor.
- Get your ER records. Look for the doctor’s notes, tests ordered and the diagnosis.
- Compare them. Does the complexity in your records match the level you were charged?
- Ask in writing. Ask the billing office to explain the level and what records support it. Keep a copy.
- Check your insurer’s EOB. Your insurer may have already lowered or questioned the level.
What comes next
Part 4 of 4 covers the bill that surprises people most: a charge from a doctor who wasn’t in your network, even though the hospital was.
Not sure your level is right? Send us your bill and records. We’ll compare the level you were charged with what your records support. Take action
This article is for general education and is not legal or medical advice.