CPT 99472 Fee Schedule

Last Verified: November 2025

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.

Subsequent 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	• None • GC - Service performed by resident under supervision • 25 - Significant, separately identifiable E/M service same day
Complexity Level	Moderate

National average reimbursement for CPT 99472 by major payers:

$509.01

$497.69

$482.88

$634.30

Preview provider-level rates for...

For billing codeCPT 99472

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 99472
United	99472	$341.10	1609088269 - HILMA BENJAMIN	952641094 - (CA) PEDIATRIC AFFILIATES MEDICAL GROUP, INC.	CA	Pediatrics Physician (208000000X)
United	99472	$90.81	1013005636 - ELAINIE DORINGO	474876858	CA	Pediatrics Physician (208000000X)
United	99472	$659.21	1295703262 - MAYRA ROSADO	954526112	CA	Pediatrics Physician (208000000X)
United	99472	$392.13	1750476891 - ROBERT NUDELMAN	952913899 - (CA) COMMUNITY PEDIATRIC MEDICAL GROUP, INC.	CA	Pediatrics Physician (208000000X)
United	99472	$499.54	1164780409 - CHERYL PERETZ	943281657	CA	Pediatrics Physician (208000000X)
United	99472	$1383.66	1619298353 - TASMINA HUSSAIN	260089066	CA	Pediatrics Physician (208000000X)
United	99472	$408.05	1710943667 - SURINDER RARON	260361411 - (CA) MARCH LANE PEDIATRIC GROUP	CA	Pediatrics Physician (208000000X)
United	99472	$2317.87	1164925921 - MATTHEW CRANSHAW	943281660	CA	Neonatal-Perinatal Medicine Physician (2080N0001X)
United	99472	$1895.30	1730386533 - ALLYSON LA BARBARA	300751669 - (CA) TAMALPAIS PEDIATRICS, A UCSF AFFILIATE	CA	Pediatrics Physician (208000000X)
United	99472	$687.54	1407301690 - SHATHA HAJJA	720276883	CA	Pediatrics Physician (208000000X)
United	99472	$1317.77	1396856373 - ANDREA ENRIGHT	260089066	CA	Pediatrics Physician (208000000X)
United	99472	$1130.06	1063892248 - REEM ITANI	953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC	CA	Pediatrics Physician (208000000X)
United	99472	$284.25	1508828856 - SRIVIMOL TANTAMJARIK	263229711 - (CA) PKA MEDICAL CORPORATION	CA	Pediatrics Physician (208000000X)
United	99472	$622.16	1184087645 - TED HANDLER	943168453	CA	Pediatrics Physician (208000000X)
United	99472	$382.76	1881654739 - TINA HONG	260089066	CA	Pediatrics Physician (208000000X)
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 99472 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes

The CPT 99472 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 99472 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
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)
99471	High	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	Moderate	Subsequent 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

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99472 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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