SAMPLE ER PROCEDURE LEVELS
Level 1
Level 2
Level 3
Level 4
 Cast/splint application, sprain
 Avulsion nail plate
 Blood transfusion
 Central line
(not pre-fabricated)
placement
 Burn dressing/debridement
 Debridement, skin and
 Epistaxis (cautery and/or
subcu

Chest tube insertion
 CPR
packing)
 Excision nail matrix
 Cricothyrotomy
 Debridement, partial or full
 FB ear, eye, nose
 FB muscle or tendon
 Delivery
thickness
 Foley/straight catheter
 Dental block
 Laceration, complex
 Exploration of
placement
penetrating wound
 FB, skin/subcu, incision and
 Lumbar puncture
 Fracture care, not restorative
removal, simple
 FB soft tissue
 Nerve block
or definitive (splint/cast only)*
 Fracture treatment with or w/o
 I&D hematoma,
 I&D
manipulation*
seroma
 IV start (without
 Gastric lavage
 I&D perianal abscess
infusion/injection)
 Gastrostomy tube change
 Peritoneal lavage
 Laceration repair
 I&D vulva, perineal, Bartholins’
 Thoracentesis
 Local treatment 1st degree
gland abscess
 Tracheostomy
burn
 Intraosseous needle placement
 Moderate sedation**
 Intubation
 Puncture aspiration
 Joint aspiration
abscess/cyst/hematoma
 Joint dislocation reduction
 Removal impacted cerumen
 Temporary pacing
 Wedge excision (ingrown
 Tendon sheath, ligament, trigger
nail)
point injection
*Apply Level 1 charge if ED physician applies splint or cast only with no fracture treatment. Apply Level 2 charge if ED physician performs reduction
of simple fractures (eg, finger, toe, metacarpal, metatarsal, distal fibula, bimalleolar and trimalleolar, distal radius). Apply Level 2 charge if ED
physician performs definitive care of simple fractures (eg, finger, toes, clavicle, rib, nasal). Apply Level 2 charge if orthopedist performs fracture
treatment.
**Do not charge moderate sedation separately because it is inherent in the following procedures:
 Chest tube insertion
 Percardiocentesis
 Central line placement in child younger than 5 years of age
 Temporary transcutaneous pacing
Do NOT charge for these procedures that are included in the visit charge:
Pre-formed splints/braces
Steri strips
Tracheostomy tube change or removal
Enema administration/Fecal disimpaction
Feeding tube removal
Insertion of nasogastric tube or oral gastric tube
Foreign body removal, skin, without incision
Nasotracheal or orotracheal suctioning
Ace wrap
Eye irrigation