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Insurance & Billing Info

HB 2041 Facility Notice

This facility is a freestanding emergency medical care facility.

This facility charges rates comparable to a hospital emergency room and may charge a facility fee.

This facility or a physician providing medical care at this facility may be an out-of-network provider for the patient’s health benefit plan provider network.

The physician providing medical care at this facility may bill separately from this facility for the medical care provided to a patient.
This facility is an out-of-network provider for all health benefit plans.

Please see the Insurance Payer Fee Schedule below

Insurance Payer Fee Schedule

Procedure Code	Description	Fee Schedule
99281	Emergency dept visit Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor.	$825.67
99282	Emergency dept visit Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity.	$1,371.99
99283	Emergency dept visit Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity.	$2,694.72
99284	Emergency dept visit Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.	$3,957.82
99285	Emergency dept visit Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.	$5,492.84
99291	Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes	$6,405.16

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