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Scope & methodology
Emergency department services (CPT 99281–99288) and critical care (99291–99292).
Critical care can occur outside the emergency department. This is a service-code view, not all services performed in an emergency room; laboratory tests, imaging, and procedures appear in their own sections.
- Quarter: the published determination quarter, which may differ from the service date. This snapshot covers 2023 Q1–2025 Q4.
- Lines: reported outcome service lines, including components and defaults; not unique patients, disputes, or procedures. Zero lines means no matching outcome rows in this snapshot.
- NPIs: distinct reported identifiers matching a 10-digit NPI format. Missing and malformed identifiers are excluded. These are not verified groups and cannot be added across codes or quarters.
- Win %: provider wins divided by provider plus insurer wins. Other or unknown winners are excluded. “Exclude defaults” restricts this rate to records explicitly marked non-default; it does not change the award sample.
- Payouts: selected awards from the independent anonymous financial sample, not confirmed collections or additional payments. Missing, suppressed, negative, and invalid awards are excluded; zero awards and duplicate-looking rows are retained. Components and unknown line types are excluded where line type is published; older files without that field are retained.
- Financial sample: mean, median, and continuous 25th–75th percentiles use usable awards from both winning sides, including defaults. Awards may cover bundles and are not per-unit prices. Hover over an amount or open a code to see sample sizes. Small samples may be unstable. “Middle 50%” sorts by the lower endpoint.
- Code scope: CPT ranges include CPT-labeled records and older records where code type was not published. HCPCS entries are included only where explicitly labeled and supported by this section. Missing or conflicting code-type labels are excluded. Descriptions are reported CMS text, using the latest available description, and are not independently verified clinical guidance.
- Separate samples: outcomes and dollars are aggregated independently by code and quarter. No row-level join or attribution of awards to named providers is made. A code may appear only in the financial sample; an unavailable award remains —, never a zero-dollar imputation.
- Overlapping sections: services may appear in more than one section, especially Surgery, Orthopedics, and ASC setting. Do not add section totals.