Trends in Emergency Department Exam Medicare Reimbursements Between 2010 and 2018

Abstract

Background: As the Medicare population continues to grow, financial pressure is placed upon hospitals, physicians, and other providers as the payer mix has an increasing proportion of Medicare patients.

Objective: The purpose of this study was to further the understanding of reimbursement trends surrounding the five levels of emergency department (ED) examinations (CPT codes 99281-99285) from 2010 to 2018 and determine how they have changed with respect to each procedure.

Methods: CPT codes were filtered into the 2010 and 2018 Physician/Supplier Procedure Summaries from the Centers for Medicare and Medicaid Services’ website to gather data on emergency physician submissions and Medicare denials and payments.

Results: In 2010, 15,669,196 ED examinations were submitted to Medicare for $7,628,693,382 while...