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See a sample rate comparisonCPT 99472 Fee Schedule
Last Verified: October 2026
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, 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
| 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 | Moderate |
| Medicare Fee Schedule | $351.71 national non-facility rate (2026) · View Medicare rates for 99472 |
| Medicaid Fee Schedule | $324.18 median of the 8 states in the free preview · View Medicaid rates for 99472 |
National average reimbursement for CPT 99472 by major payers:
$509.01
$497.69
$482.88
$633.81
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CPT 99472
5 of 25 sample ratesHigher to lower in this preview
Allyson La Barbara
Tamalpais Pediatrics, A Ucsf Affiliate
$1,895.30Published rateShelli Bein
Baychildrens Physicians
$1,205.02Published rateCheryl Peretz
$499.54Published rateChildren'S Medical Clinic Of Santa Barbara Inc
Childrens Medical Clinic Of Santa Barbara, Inc.
$356.42Published rateSrivimol Tantamjarik
Pka Medical Corporation
$284.25Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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