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2025 CPT code 99281

Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional.

This code is used for the lowest level of emergency department visits.It is used when the patient's condition does not require the presence of a physician, and the services can be provided by other qualified healthcare professionals such as a nurse or technician.Do not use this code if the patient is seen in the emergency department for the convenience of the physician. In such cases, use office visit codes (99202-99215).As of 2023, selection of this code is based on medical decision-making and not on the key components of history, exam, and medical decision making.

Modifiers may be applicable to further specify the service provided.

Medical necessity for this code is met when a patient presents to the emergency department with a medical concern, even if the concern is minor and does not require the direct attention of a physician.

The provider performs an evaluation and management (E/M) service for a patient in the emergency department.This level of service may not require the presence of a physician but can be performed by other qualified healthcare professionals.

In simple words: The provider sees a patient for the lowest level emergency department visit. This visit may not require the direct presence of a physician.

Emergency department visit for the evaluation and management of a patient, which may not require the presence of a physician or other qualified healthcare professional.

Example 1: A patient presents to the emergency department with a minor insect bite. A nurse assesses the bite, cleans the area, and provides instructions on home care., A patient comes to the emergency department for a routine blood pressure check. A technician takes the patient's blood pressure and reports the results to a nurse., A patient visits the emergency department for a scheduled tuberculosis (TB) skin test reading.A nurse reads the test and documents the results.

Documentation should support the level of service provided, even if minimal.This may include a brief note documenting the presenting problem, the assessment performed, and any instructions or treatment provided.

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