CPT 99474 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 | Inpatient Neonatal and Pediatric Critical Care Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | None U1 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99474 |
National average reimbursement for CPT 99474 by major payers:
$18.55
$18.69
$16.26
$31.77
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 99474 | $30.09 | 1811336092 - GUY DOOLEY | 570370242 - MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC | TX | Internal Medicine Physician (207R00000X) |
United | 99474 | $7.67 | 1720285661 - IKEDIEZE CHUKWU | 460793836 - (TX) REGENT CROSS MEDICAL CLINIC, LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99474 | $44.38 | 1184625428 - MARK GILCHRIST | 274317046 - (MA) MARK G. GILCHRIST, M.D., LLC | MA | Pediatrics Physician (208000000X) |
United | 99474 | $20.01 | 1760662282 - JOE BOWERS | 752616977 - CHRISTUS TRINITY CLINIC | TX | Neurology Physician (2084N0400X) |
United | 99474 | $32.50 | 1730105024 - KARIN WOODMAN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TX | Neurology Physician (2084N0400X) |
United | 99474 | $44.38 | 1851330948 - LISA SEVIGNY | 274317046 - (MA) MARK G. GILCHRIST, M.D., LLC | MA | Pediatrics Physician (208000000X) |
United | 99474 | $35.11 | 1184883548 - PATRICIA PETERS | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99474 | $21.97 | 1881636231 - ARCHANA SRIVASTAVA | 814325105 - (TX) ARCHANA SRIVASTAVA MD PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99474 | $30.47 | 1134126691 - SAFOORA HARANDI | 331072418 - (TX) WEST PLANO MEDICAL ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99474 | $37.47 | 1689634180 - PADRAIG OSUILLEABHAIN | 756002868 | TX | Neurology Physician (2084N0400X) |
United | 99474 | $15.11 | 1417339409 - LEONEL ESTOFAN | 204701276 | TX | Neurology Physician (2084N0400X) |
United | 99474 | $15.56 | 1386077378 - RASHID ATIQUE | 922465140 | TX | Internal Medicine Physician (207R00000X) |
United | 99474 | $26.07 | 1346283439 - KEVIN THELEMAN | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99474 | $7.21 | 1669684189 - PAUL WELLS | 263053357 - (TX) PAUL H WELLS ASSOCIATES MDPA | TX | Internal Medicine Physician (207R00000X) |
United | 99474 | $19.62 | 1780099093 - INTERNAL MEDICINE OF PASADENA, PLLC | 611734356 - (TX) INTERNAL MEDICINE OF PASADENA PLLC | 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 99474 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99474 code is part of the Inpatient Neonatal and Pediatric Critical Care 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.
| Code | Complexity | Description |
|---|---|---|
| 99450-CPT | Low | Basic Life Disability Exam, 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-CPT | Low | Ntrprof Ph1 Ntrnet Ehr Rfrl, Interprofessional Telephone Internet Electronic Health Record Referral Service S Provided By A Treating Requesting Physician Or Other Qualified Health Care Professional 30 Minutes |
| 99457-CPT | Low | Rpm Tx Mgmt 1st 20 Min, Remote Physiologic Monitoring Treatment Management Services Clinical Staff/Physician/Other Qualified Health Care Professional Time In A Calendar Month Requiring 1 Real-Time Interactive Communication With The Patient/Caregiver During The Calendar Month; First 20 Minutes |
| 99474-CPT | Low | Self Meas Bp 2 Readg Bid 30d, 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 Pressures And Subsequent Communication Of A Treatment Plan To The Patient |
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.
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