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See a sample rate comparisonCPT 99475 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.
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
| 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 23 - Emergency Room |
| Common Modifiers | GC - Service performed by resident under supervision 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $473.96 national non-facility rate (2026) · View Medicare rates for 99475 |
| Medicaid Fee Schedule | $445.14 median of the 8 states in the free preview · View Medicaid rates for 99475 |
National average reimbursement for CPT 99475 by major payers:
$730.59
$699.38
$648.04
$882.60
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CPT 99475
5 of 25 sample ratesHigher to lower in this preview
Jillian Olsen
$3,226.45Published rateSean Alloju
Methodist Medical Center Of Illinois
$1,230.96Published rateMatthew Jepson
Austin Heart, P.A.
$975.15Published rateKhavar Dar
Odessa Medical Enterprises PLLC
$628.44Published rateVeronica Zayas-Torres
Aids Healthcare Foundation
$489.29Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99475 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99475 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 99475 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 99475. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99475 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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