CPT 99467 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 | Low |
National average reimbursement for CPT 99467 by major payers:
$161.66
$149.22
$137.88
$193.43
| 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 99467 | ||||||
United | 99467 | $95.02 | 1508040098 - JOHN SORRELLS | 473308393 - (TX) GENERATIONS VISITING PRACTITIONERS LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $177.85 | 1467987503 - TIFFANY BROWN | 942854057 - IHC HEALTH SERVICES INC | TX | Neurology Physician (2084N0400X) |
United | 99467 | $128.08 | 1821288085 - ABDUL RASHID | 923677515 - (TX) PRIME CARDIOVASCULAR VEIN CENTER PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99467 | $97.58 | 1063799567 - HEART & VASCULAR CLINIC OF SAN ANTONIO, PLLC | 453417704 - (TX) HEART VASCULAR CLINIC OF SAN ANTONIO PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99467 | $139.00 | 1801048285 - RAMIN ANSARI | 260592487 - (TX) SHETH MD PA | TX | Neurology Physician (2084N0400X) |
United | 99467 | $158.17 | 1538523527 - SUNIL KAMNANI | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $197.72 | 1962407353 - REBECA SHARP | 920813243 - (TX) CATALYST PHYSICIAN GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $97.76 | 1134164577 - DARIUS WANIA | 760527390 - ALIEF MEDICAL CLINIC DBA FUIJI FAMILY HEALTH CARE | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $123.58 | 1922205780 - ANIS A ANSARI MD PA | 752680891 - (TX) ANIS A. ANSARI, MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $103.68 | 1952311326 - STEPHEN TSENG | 742805218 - (TX) STEPHEN S. TSENG, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $122.51 | 1215186531 - KRYSTIN BAKER | 200737321 - (FL) BAPTIST PHYSICIAN ASSOCIATES LLC | TX | Neurology Physician (2084N0400X) |
United | 99467 | $238.39 | 1104850866 - SWATI SANE | 42472266 - (MA) RELIANT MEDICAL GROUP, INC. | MA | Pediatrics Physician (208000000X) |
United | 99467 | $135.47 | 1689610750 - MEENU SHARMA | 813318371 - (TX) WELL CREST MEDICAL CLINIC PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99467 | $135.47 | 1629054358 - DHIREN SHAH | 752061371 - (TX) CARDIOLOGY CONSULTANTS OF NORTH DALLAS, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99467 | $99.91 | 1154344042 - AUGUSTINE O. ELEJE, MD, PA | 562559985 - (TX) AUGUSTINE O. ELEJE, MD, PA | 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 99467 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99467 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 99467 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-CPT | 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-CPT | 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-CPT | 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-CPT | 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 99467. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99467 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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