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See a sample rate comparisonCPT 99471 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Initial Inpatient Pediatric Cr, Initial Inpatient Pediatric Critical Care Per Day For The Evaluation And Management Of A Critically Ill Infant Or Young Child 29 Days Through 24 Months Of Age
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | GC - Service performed by resident under supervision 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | High |
| Medicare Fee Schedule | $674.36 national non-facility rate (2026) · View Medicare rates for 99471 |
| Medicaid Fee Schedule | $632.90 median of the 8 states in the free preview · View Medicaid rates for 99471 |
National average reimbursement for CPT 99471 by major payers:
$1,020.63
$997.02
$931.22
$1,248.93
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CPT 99471
5 of 25 sample ratesHigher to lower in this preview
Pooja Rutberg
Harvard Medical Faculty Phys At Beth Israel Deaconess Med Ctr Inc
$2,487.76Published rateHilary Branch
Baystate Medical Practices Inc
$1,205.43Published rateKevin Garnepudi
Mohammad Omer Khan PA
$968.30Published rateSyed Ali
Syed T Ali Md PLLC
$787.15Published rateServe All Medical Round Rock, PLLC, Clinica Hispana
Serve All Medical Round Rock PLLC
$608.75Published rate
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See a sample payer proposalCPT 99471 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99471 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 99471 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 |
|---|---|---|
| 99471-CPT | High | Initial Inpatient Pediatric Cr, Initial Inpatient Pediatric Critical Care Per Day For The Evaluation And Management Of A Critically Ill Infant Or Young Child 29 Days Through 24 Months Of Age |
| 99472-CPT | Moderate | Subsequent Inpatient Pediatric, Subsequent Inpatient Pediatric Critical Care Per Day For The Evaluation And Management Of A Critically Ill Infant Or Young Child 29 Days Through 24months Of Age |
| 99475-CPT | Moderate | Initial Inpatient Pediatric Cr, Initial Inpatient Pediatric Critical Care Per Day For The Evaluation And Management Of A Critically Ill Infant Or Young Child 2 Through 5 Years Of Age |
| 99476-CPT | Moderate | Subsequent Inpatient Pediatric, Subsequent Inpatient Pediatric Critical Care Per Day For The Evaluation And Management Of A Critically Ill Infant Or Young Child 2 Through 5 Years Of Age |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99471. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99471 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. These are a set of medical codes used by physicians, allied health professionals, hospitals, and other healthcare providers to report medical, surgical, diagnostic, and other services to entities such as insurance companies and government payers. They are essential for accurate billing and documenting healthcare services.
Finding the exact cost of a medical procedure or service can be complex as prices vary significantly based on your insurance plan, geographic location, specific provider, and the CPT codes involved. For specific pricing information tailored to your situation, based on CPT codes and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for prices with a CPT code and specific location, helping you understand potential costs.
CPT (Current Procedural Terminology) codes are a subset of HCPCS (Healthcare Common Procedure Coding System) codes. CPT codes (Level I HCPCS) primarily describe medical procedures and services performed by physicians and other healthcare providers. HCPCS Level II codes describe non-physician services such as ambulance services, durable medical equipment, prosthetics, orthotics, and supplies. Both systems are used for billing and to ensure consistent communication about medical services.
CMS (Centers for Medicare & Medicaid Services) does publish some pricing information, particularly related to Medicare reimbursement rates for services and procedures. However, this information is primarily for Medicare beneficiaries and providers, and may not directly reflect the out-of-pocket costs for individuals with private insurance or the negotiated rates across all payers. For specific pricing relevant to your situation, including services covered by various payers and locations, tools like Payerprice can be more directly helpful as they allow you to search with a CPT code and your specific location.
Comparing prices for medical services can help you make informed decisions about your healthcare. Many factors influence cost, including your insurance plan, the specific provider, and your geographic location. To effectively compare prices based on specific CPT codes and your location, you can use specialized tools. Payerprice, for instance, offers a fee schedule lookup tool that enables you to search for pricing information using a CPT code and your specific location, allowing you to compare potential costs from different providers or payers.