CPT 99466 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services |
| Common Place of Service | • 41 - Ambulance - Land • 21 - Inpatient Hospital • 42 - Ambulance - Air or Water |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • SA |
| Complexity Level | Moderate |
National average reimbursement for CPT 99466 by major payers:
$310.34
$300.09
$278.12
$380.44
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99466 | ||||||
United | 99466 | $351.42 | 1073641007 - MAJD JWIED | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $683.59 | 1396720264 - SONIA DIAZ | 42807148 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99466 | $572.60 | 1376856039 - FIDELIS OKOTIE | 391138241 - ASPIRUS WAUSAU HOSPITAL INC | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $165.88 | 1164471702 - KEITH HUYNH | 760548619 - (TX) KEITH A. HUYNH, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $211.63 | 1871570705 - MICHAEL ROTENBERG | 760386549 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99466 | $194.58 | 1477525384 - MAXIMILIANO HERNANDEZ | 742898592 - (TX) MAXIMILIANO E. HERNANDEZ, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $218.91 | 1932595964 - UZAIR MUSHTAQ | 853804440 - (TX) TRANSITIONAL CARE PHYSICIANS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $200.19 | 1124117411 - LIBERTY DIAGNOSTIC CLINIC, BASSAM A HAMID MD | 760489376 - (TX) LIBERTY DIAGNOSTIC CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $212.94 | 1922147941 - BINU SUGUNAN | 474038606 - (TX) CH SPECIALTY SERVICES TX PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $601.29 | 1982923785 - RODRIGO ZEPEDA | 756002868 | TX | Neurology Physician (2084N0400X) |
United | 99466 | $218.91 | 1841289030 - FERNANDO ARZOLA | 710992609 | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $387.48 | 1093797193 - KASI CHEKURI | 320439879 - (TX) CORPUS CHRISTI HEART CLINIC PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99466 | $231.08 | 1477525384 - MAXIMILIANO HERNANDEZ | 742898592 - (TX) MAXIMILIANO E. HERNANDEZ, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99466 | $401.35 | 1154760320 - YEVGENIY KHARITON | 742958277 - SCOTT & WHITE CLINIC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99466 | $267.55 | 1972563286 - ALAN CARPENTER | 203897330 - (TX) UPPER VALLEY URGENT CARE CENTER, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99466 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99466 code is part of the Evaluation and Management services used for Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99466 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99291 | Moderate | Citical Care, Evaluation And Management Of The Unstable Critically Ill Or Unstable Critically Injured Patient, Requiring The Constant Attendance Of The Physician; Ist Hour |
| 99466 | Moderate | Critical Care Face-To-Face Services During An Interfacility Transport Of Critically Ill Or Critically Injured Pediatric Patient 24 Months Ofage Or Younger; First 30-74 Minutes Of Hands-On Care During Transport (Revised 01/01/13) |
| 99467 | Low | Critical Care Face-To-Face Services During An Interfacility Transoport Of Critically Ill Or Critically Injured Pediatric Patient 24 Months Ofage Or Younger; Each Additional 30 Minutes (List Separately In Addition To Code For Primary Service) (Revised 01/01/13) |
| 99468 | High | Initial Inpatient Neonatal Critical Care, Per Day, For The Evaluation And Management Of A Critically Ill Neonate, 28 Days Of Age Or Younger |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99466. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99466 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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