Evaluation and management (99202–99499): Federal IDR outcomes by code
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 1,466,249 | 84.0% | 3.10x | 1,337,107 | – |
| 99285 Emergency department visit with high level of medical decision making | 909,151 | 83.2% | 2.85x | 801,298 | – |
| 99283 Emergency department visit with low level of medical decision making | 409,835 | 82.2% | 3.28x | 371,848 | – |
| 99291 Critical care, first 30-74 minutes | 118,802 | 85.2% | 3.28x | 103,666 | – |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 41,258 | 86.9% | 3.51x | 40,433 | – |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 33,580 | 82.1% | 3.11x | 33,045 | – |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 22,157 | 84.2% | 2.91x | 20,365 | – |
| 99239 Hospital discharge day management, more than 30 minutes | 12,922 | 83.1% | 2.98x | 12,720 | – |
| 99282 Emergency department visit with straightforward medical decision making | 10,952 | 78.9% | 4.50x | 9,858 | – |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 10,020 | 78.2% | 2.86x | 9,919 | – |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 7,735 | 79.0% | 2.48x | 7,639 | – |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 7,670 | 85.8% | 7.45x | 7,272 | – |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 6,954 | 80.6% | 3.06x | 6,828 | – |
| 99238 Hospital discharge day management, 30 minutes or less | 4,543 | 83.4% | 4.34x | 4,310 | – |
| 99236 Initial hospital care with same-day admission and discharge with high level of m | 4,493 | 84.5% | 8.64x | 4,204 | – |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 3,627 | 79.2% | 3.22x | 3,599 | – |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 3,082 | 83.2% | 27.25x † | 2,879 | – |
| 99292 Critical care, each additional 30 minutes | 2,797 | 83.4% | 5.77x | 1,999 | – |
| 99281 Emergency department visit for problem that may not require health care professi | 1,554 | 74.1% | 6.25x | 1,348 | – |
| 99468 Initial inpatient hospital critical care of newborn per day (28 days or younger) | 1,446 | 80.5% | 2.24x | 1,422 | – |
| 99214 Established patient office or other outpatient visit with moderate level of deci | 1,198 | 87.1% | 11.48x | 1,006 | – |
| 99221 Initial hospital care with straightforward or low level of medical decision maki | 1,189 | 79.2% | 10.77x | 1,136 | – |
| 99235 Initial hospital care with same-day admission and discharge with moderate level | 1,162 | 87.3% | 11.28x | 1,072 | – |
| 99460 Initial evaluation and management of newborn per day | 908 | 83.9% | 3.19x | 905 | – |
| 99204 New patient office or other outpatient visit with moderate level of medical deci | 895 | 88.6% | 5.40x | 807 | – |
| 99497 Advance care planning, first 30 minutes | 810 | 78.5% | 6.85x | 794 | – |
| 99478 Follow-up intensive care of recovering very low birth weight infant per day | 756 | 83.1% | 2.53x | 756 | – |
| 99477 Initial intensive care of newborn per day (28 days or younger) | 602 | 78.6% | 2.52x | 600 | – |
| 99220 Initial hospital observation care per day, typically 70 minutes | 579 | 66.8% | 1.37x | 321 | – |
| 99203 New patient office or other outpatient visit with low level of medical decision | 533 | 85.6% | 11.90x | 512 | – |
| 99418 Prolonged inpatient or observation service, each 15 minutes of total time beyond | 520 | 91.3% | 2.56x | 348 | – |
| 99234 Initial hospital care with same-day admission and discharge with straightforward | 513 | 83.2% | 15.80x | 460 | – |
| 99213 Established patient office or other outpatient visit with low level od decision | 498 | 87.6% | 14.73x | 457 | – |
| 99406 Smoking and tobacco use intensive counseling, 4-10 minutes | 333 | 86.2% | 3.53x | 226 | – |
| 99255 Hospital consultation with high level of medical decision making, if using time, | 305 | 73.1% | 7.87x | 293 | – |
| 99462 Follow-up hospital care of newborn per day | 261 | 82.8% | 2.94x | 261 | – |
| 99217 Hospital observation care on day of discharge | 256 | 70.3% | 2.05x | 208 | – |
| 99205 New patient office or other outpatient visit with a high level of medical decisi | 224 | 86.2% | 10.47x | 216 | – |
| 99215 Established patient office or other outpatient visit with high level of medical | 201 | 89.6% | 9.54x | 184 | – |
| 99202 New patient office or other outpatient visit with straightforward medical decisi | 147 | 92.5% | 11.96x | 79 | – |
| 99464 Physician attendance at delivery and stabilization of newborn | 145 | 91.0% | 3.45x | 144 | – |
| 99465 Reviving newborn at delivery | 139 | 77.7% | 2.75x | 139 | – |
| 99360 Extended physician standby service, each 30 minutes | 117 | 85.5% | 9.11x | 39 | – |
| 99463 Initial inpatient hospital or birthing center same date care and discharge of ne | 103 | 78.6% | 2.53x | 103 | – |
| 99254 Hospital consultation with moderate level of medical decision making, if using t | 94 | 80.9% | 6.04x | 87 | – |
| 99219 Initial hospital observation care per day, typically 50 minutes | 91 | 78.0% | 2.30x | 60 | – |
| 99218 Initial hospital observation care per day, typically 30 minutes | 89 | 69.7% | 2.16x | 83 | – |
| 99212 Established patient office or other outpatient visit with straightforward medica | 68 | 88.2% | 38.23x † | 63 | – |
| 99471 Initial inpatient hospital critical care of infant or young child per day (29 da | 53 | 81.1% | 2.30x | 52 | – |
| 99476 Follow-up inpatient hospital critical care of infant or young child per day (2-5 | 52 | 90.4% | 5.54x | 52 | – |
| 99211 Office or other outpatient visit for the evaluation and management of establishe | 49 | 85.7% | 175.14x † | 34 | – |
| 99225 Follow-up observation care per day, typically 25 minutes | 47 | 70.2% | 2.16x | 45 | – |
| 99253 Hospital consultation with low level of medical decision making, if using time, | 46 | 87.0% | 5.61x | 43 | – |
| 99226 Follow-up observation care per day, typically 35 minutes | 44 | 75.0% | 2.19x | 44 | – |
| 99349 Residence visit for established patient with moderate level of medical decision | 36 | 97.2% | 15.09x | 36 | – |
2023 Q1–2025 Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by code
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 1,161,936 | $2.91B | $660 | $213 | 6.02x |
| 99285 Emergency department visit with high level of medical decision making | 676,409 | $1.52B | $852 | $286 | 3.45x |
| 99283 Emergency department visit with low level of medical decision making | 304,512 | $1.26B | $979 | $169 | 10.39x |
| 99291 Critical care, first 30-74 minutes | 83,118 | $172.4M | $1,028 | $313 | 2.82x |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 36,144 | $29.2M | $278 | $84 | 8.61x |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 29,881 | $22.9M | $398 | $125 | 4.60x |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 17,813 | $25.9M | $685 | $234 | 5.50x |
| 99239 Hospital discharge day management, more than 30 minutes | 10,946 | $6.5M | $398 | $128 | 4.34x |
| 99282 Emergency department visit with straightforward medical decision making | 8,312 | $15.4M | $1,581 | $283 | 5.42x |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 6,262 | $3.9M | $616 | $243 | 2.35x |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 5,938 | $11.9M | $1,239 | $163 | 11.31x |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 4,635 | $8.5M | $1,937 | $823 | 1.98x |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 3,929 | $2.3M | $593 | $225 | 2.39x |
| 99236 Initial hospital care with same-day admission and discharge with high level of m | 3,664 | $16.3M | $4,217 | $353 | 10.47x |
| 99238 Hospital discharge day management, 30 minutes or less | 3,256 | $5.5M | $421 | $91 | 15.72x |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 2,473 | $8.8M | $2,250 | $49 | 10.69x |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 2,107 | $4.5M | $1,952 | $550 | 3.11x |
| 99292 Critical care, each additional 30 minutes | 1,296 | $4.1M | $1,968 | $232 | 6.72x |
| 99281 Emergency department visit for problem that may not require health care professi | 944 | $1.9M | $1,746 | $209 | 7.52x |
| 99214 Established patient office or other outpatient visit with moderate level of deci | 840 | $1.1M | $1,265 | $91 | 12.53x |
| 99235 Initial hospital care with same-day admission and discharge with moderate level | 714 | $2.5M | $4,000 | $244 | 11.61x |
| 99221 Initial hospital care with straightforward or low level of medical decision maki | 710 | $1.8M | $1,806 | $127 | 7.00x |
| 99204 New patient office or other outpatient visit with moderate level of medical deci | 670 | $893,667 | $1,018 | $168 | 6.76x |
| 99497 Advance care planning, first 30 minutes | 659 | $1.3M | $755 | $98 | 14.39x |
| 99468 Initial inpatient hospital critical care of newborn per day (28 days or younger) | 463 | $1.7M | $4,425 | $2,011 | 1.62x |
| 99203 New patient office or other outpatient visit with low level of medical decision | 419 | $623,989 | $995 | $85 | 13.11x |
| 99460 Initial evaluation and management of newborn per day | 376 | $142,476 | $418 | $120 | 2.84x |
| 99213 Established patient office or other outpatient visit with low level od decision | 368 | $594,697 | $1,056 | $63 | 19.57x |
| 99478 Follow-up intensive care of recovering very low birth weight infant per day | 366 | $267,745 | $699 | $287 | 2.47x |
| 99234 Initial hospital care with same-day admission and discharge with straightforward | 339 | $1.2M | $3,000 | $188 | 15.97x |
| 99418 Prolonged inpatient or observation service, each 15 minutes of total time beyond | 309 | $772,044 | $1,100 | $195 | 1.93x |
| 99255 Hospital consultation with high level of medical decision making, if using time, | 247 | $882,516 | $1,650 | $243 | 13.65x |
| 99205 New patient office or other outpatient visit with a high level of medical decisi | 134 | $465,522 | $5,000 | $193 | 14.35x |
| 99477 Initial intensive care of newborn per day (28 days or younger) | 131 | $243,539 | $1,721 | $742 | 2.32x |
| 99406 Smoking and tobacco use intensive counseling, 4-10 minutes | 77 | $8,957 | $75 | $17 | 6.47x |
| 99462 Follow-up hospital care of newborn per day | 69 | $11,544 | $153 | $52 | 3.12x |
| 99220 Initial hospital observation care per day, typically 70 minutes | 59 | $30,073 | $477 | $165 | 2.05x |
| 99215 Established patient office or other outpatient visit with high level of medical | 41 | $136,715 | $4,950 | $123 | 19.31x |
2024 Q3–2025 Q4 · CMS QPA and Offers file · rows with n ≥ 30 line items with dollar amounts · sorted by n · Award ×QPA = total awarded ÷ total QPA.