CPT 99474 Fee Schedule
Last Updated: April 2025
Self-Measured Blood Pressure Using A Device Validated For Clinical Accuracy; Separate Self-Measurements Of Two Readings One Minute Apart Twice Daily Over A 30-Day Period (Minimum Of 12 Readings) Collection Of Data Reported By The Patient And/Or Caregiver To The Physician Or Other Qualified Health Care Professional With Report Of Average Systolic And Diastolic Pressuresand Subsequent Communication Of A Treatment Plan To The Patient
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 | • 11 - Office • None • 99 - Other Place of Service |
| Common Modifiers | • None • U1 • 95 - Synchronous telemedicine service via real-time audio and video telecommunications |
| Complexity Level | Moderate |
National average reimbursement for CPT 99474 by major payers:
$18.55
$18.72
$16.26
$33.82
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99474. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99474 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.
CPT 99474 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99474 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 99474 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 99450 | Moderate | Basic Life And/Or Disability Examination That Includes; Measurement Of Height Weight And Blood Pressure; Completion Of A Medical History Following A Life Insurance Pro Forma; Collection Of Blood Sample And/Or Urinalysis Complying With Chain Of Custody Protocols; And Completion Of Necessary Documentation/Certificates. |
| 99452 | Low | Interprofessional Telephone/Internet/Electronic Health Record Referral Service(S) Provided By A Treating/Requesting Physician Or Other Qualified Health Care Professional 30 Minutes |
| 99457 | Low | Remote Physiologic Monitoring Treatment Managementservices Clinical Staff/Physician/Other Qualifiedhealth Care Professional Time In A Calendar Month Requiring Interactive Communication With The Patient/Caregiver During The Month; First 20 Minutes (Desc Rvsd 1/1/20) |
| 99474 | Low | Self-Measured Blood Pressure Using A Device Validated For Clinical Accuracy; Separate Self-Measurements Of Two Readings One Minute Apart Twice Daily Over A 30-Day Period (Minimum Of 12 Readings) Collection Of Data Reported By The Patient And/Or Caregiver To The Physician Or Other Qualified Health Care Professional With Report Of Average Systolic And Diastolic Pressuresand Subsequent Communication Of A Treatment Plan To The Patient |
See what providers are getting paid in 2024 for 99474:
CPT 99474 Fee Schedule & Reimbursement Rates
The CPT 99474 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99450 | $228.24 | ||
| 99452 | $33.62 | $61.58 | |
| 99457 | $48.93 | $86.83 | |
| 99458 | $39.28 | $71.91 | |
| 99473 | $14.31 | ||
| 99474 | $16.64 | $33.82 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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