What Is a Level 5 Emergency Room Visit, and Why Does It Cost So Much?

If you visit the emergency room, your bill will typically include a "ER visit level" line item that’s based on the complexity of your treatment. A Level 5 emergency room visit, or ER visit level 5, is reserved for the most severe cases.

Visit levels range from 1 to 5, from mild to most severe, and most ER visits fall around level 3 or level 4, explains Goodbill lead medical coder, Christine Fries.

A Level 5 emergency room visit charge is reserved for the most severe cases. Most visits fall around level 3 or 4.

Generally speaking, you’re billed for an ER visit level 4 if you get two or fewer diagnostic tests, which can include labs, EKGs or X-rays. Once you get three or more diagnostic tests, you’ll be billed for an ER visit level 5.

‍Read more ER visit levels here: Why Did My Emergency Room Visit Cost So Much?

But watch out: Hospitals sometimes inflate the leveling on your bill, also known as "upcoding," even if your visit didn’t meet the criteria for that level. The difference in cost between an ER visit level 4 and an ER visit level 5 can be thousands of dollars, she says.

ER visit levels are sometimes inflated on your bill, known as "upcoding." The difference in cost can be thousands of dollars.

"That’s probably the line we see most often stepped over, is they’re billing that ER visit level 5, when it just wasn’t there," Fries told patient advocacy nonprofit Healthcare Reformed in an interview. "With just a single line item flagged as upcoding between an ER visit level 4 and 5, we’ve saved patients over $2,000." 

On your bill, a Level 5 emergency room visit charge may show up differently, depending on the hospital. Here are some common ways it might appear on your bill:

• Level 5 ED visit
• ER visit level 5 / ER visit lvl 5
• ED visit level 5 / ED visit lvl 5
• CPT 99285

To learn more, listen to Fries' full video interview below.