The emergency room (ER) is a critical and life-saving source of care for many Americans, but the resulting medical bills that patients receive can be a source of confusion and extreme financial burden. From incredibly high, varying prices to surprise bills resulting from in/out of network confusion, many Americans have no idea what to expect when it comes to the cost of ER services. Policymakers are taking increased action to reduce the uncertainties and high costs associated with ER care. For example, federal action protects patients from "surprise" ER bills for out-of-network services and state action tracks and addresses ER upcoding.
To inform these efforts, HCCI has updated our earlier analysis of ER spending, price, and use trends with data from 2012 to 2021. Using HCCI's claims dataset for over one-third of people with health insurance through their job, we examined the 5 successive Current Procedural Terminology (CPT) codes for an ER Evaluation and Management (E&M) visit, which are designed to capture the level of severity and complexity. We report spending and price for just these ER E&M procedures as well as the total ER spending and price for all services performed during an ER visit.
The average price for an ER E&M visit increased by 73% between 2012 and 2021. The price growth was driven by price increases for ER visits of each severity and more use of the high severity codes (99284 and 99285), which have higher prices.
We also observed that, from 2012 to 2021 (Figure 1):
ER E&M spending per person increased 55%
ER E&M use declined 10%, with most of the decline occurring in 2020
ER E&M spending growth was largely driven by higher severity visits (99284 and 99285)
Per-person spending on the highest severity (99285) ER E&M visit rose 135%, with price increasing 56% and use increasing 50%.
The average price for an ER visit when all services performed during the visit are included was more than double the price of the ER E&M procedure alone (Figure 2). In 2021, the average price of an ER E&M visit (including facility and professional costs) was $1,317 and the average price of an ER visit including all services was $2,909. This price difference was larger for high severity (99285) visits, which are more likely to include higher cost ancillary services needed to diagnose and treat these cases.
HCCI is releasing a state-level downloadable data table and interactive tool to allow users to observe the ER spending, price, and utilization trends by state from 2012 to 2021.
How to use the tool:
Use the drop-down menu in the top left corner to view ER spending trends at the national level or for any state. From left to right, the three panels of the graph show the 2012-2021 cumulative change in spending, price, and utilization trends for the severity-based emergency room evaluation and management CPT codes for ER visits and all codes combined. Hover over the lines or dots to view details.
This analysis used HCCI research data of health insurance claims for people under the age of 65 who get their insurance through an employer. We identified emergency room (ER) visits using facility claims with CPT codes of 99281-99285. ER Evaluation and Management (E&M) measures included the spending for facility and professional claim lines for the E&M procedure codes (99281-99285). All ER services measures included spending for all claim lines, facility and professional, that occurred on the same date as an ER visit.