Why do I have two emergency visit charges?

Usually one is from the hospital (the facility) and one from the emergency physician (the professional fee). Each sets its own level, and they can differ.

Does a higher level mean I was more seriously ill?

Not exactly. For the physician charge, the level reflects how complex the medical decisions were, including tests reviewed and risks considered, which can be high even when the outcome is reassuring.

Emergency room visit levels explained (level 1 to 5)

What the level on an ER bill means, why it can make the bill much larger, and what to ask about how the level was chosen.

Last updated 2026-09-25

Emergency room visits are billed at one of five levels. The level is often the largest single number on an ER bill, so it is worth understanding.

The five levels

Emergency physician visits use the codes 99281 to 99285. Level 1 (99281) is the simplest and level 5 (99285) the most complex. Since 2023, the physician's level is based on the complexity of the medical decision making: how many problems were addressed, what was reviewed or ordered, and how much risk was involved.

The hospital also bills its own emergency visit level for the facility, under the emergency room revenue codes. Each hospital sets its own criteria for its levels, based on the resources used.

Why the level matters

Moving up a level can add hundreds of dollars to each of the two charges. A level 5 visit for a problem that took little time or testing is a reasonable thing to ask about.

What to ask

"Which level was billed for the facility and which for the physician?"
"What in my visit supported that level?"
"Can you show me the itemized charges for the tests and supplies?"

Asking how a level was chosen is a normal question. Billing offices answer it regularly.

Open your ER bill in MedBillCheckup (it is read on your device and never uploaded) and we will separate the facility and physician charges, show the visit level, and list the questions to ask.

Common questions

Why do I have two emergency visit charges?: Usually one is from the hospital (the facility) and one from the emergency physician (the professional fee). Each sets its own level, and they can differ.
Does a higher level mean I was more seriously ill?: Not exactly. For the physician charge, the level reflects how complex the medical decisions were, including tests reviewed and risks considered, which can be high even when the outcome is reassuring.

Check your own bill

Open it in MedBillCheckup and your browser will read the charges (the bill never leaves your device), then run these checks for you and write out what to ask. Reading is free and needs no account.

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