CPT 99476 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 | • Evaluation and Management • Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services |
| Common Place of Service | • 21 - Inpatient Hospital • None • 22 - On Campus Outpatient Hospital |
| 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 99476 by major payers:
$441.53
$426.12
$391.93
$536.90
| 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 99476 | ||||||
United | 99476 | $421.94 | 1972766467 - MANU PILLAI | 882557289 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99476 | $618.09 | 1699111666 - JULIAN SWANSON | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $884.71 | 1124490701 - LEXINGTON PEDIATRICS, LLC | 475190965 - (MA) LEXINGTON PEDIATRICS, LLC | MA | Pediatrics Physician (208000000X) |
United | 99476 | $264.05 | 1518991447 - PADMINI BHADRIRAJU | 271724682 - (TX) PADMINI BHADRIRAJU MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $709.78 | 1902288020 - NICOLE JOHNSON | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $290.92 | 1861438525 - DAVID LE | 760605772 | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $709.78 | 1396822581 - JEHANGIR GOWANI | 861407827 - (TX) QUICK CARE CLINICS LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $319.82 | 1609973650 - GEORGE WILCOX | 475300786 - (TX) INPATIENT PROGRESSIVE HEALTHCARE OF AMERICA | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $875.05 | 1851347504 - MONICA ULTMANN | 43400617 - TUFTS MEDICAL CENTER PARENT INC | MA | Pediatrics Physician (208000000X) |
United | 99476 | $331.86 | 1548228927 - STEVEN BAUER | 742574229 - (TX) WELLMED MEDICAL GROUP, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99476 | $882.83 | 1093247306 - COURTNEY MCGUIRE | 43400617 - TUFTS MEDICAL CENTER PARENT INC | MA | Pediatrics Physician (208000000X) |
United | 99476 | $925.07 | 1629079801 - PRAKASHKUMAR PATEL | 871785388 - (WI) FROEDTERT MANITOWOC MEDICAL GROUP LLC | TX | Neurology Physician (2084N0400X) |
United | 99476 | $346.92 | 1558351635 - KATY-ANN HANNIGAN | 43163589 - (MA) HEYWOOD MEDICAL GROUP INC | MA | Pediatrics Physician (208000000X) |
United | 99476 | $371.35 | 1124199187 - AHMAD SABOUNI | 871491830 - (TX) WEST TEXAS NEUROLOGY CLINIC LLC | TX | Neurology Physician (2084N0400X) |
United | 99476 | $481.51 | 1073959516 - ROY ZHANG | 384109786 - (TX) UT PHYSICIANS | TX | Neurology Physician (2084N0400X) |
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 99476 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99476 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 99476 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-CPT | 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) |
| 99468-CPT | High | Initial Inpatient Neonatal Critical Care, Per Day, For The Evaluation And Management Of A Critically Ill Neonate, 28 Days Of Age Or Younger |
| 99471-CPT | 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 |
| 99476-CPT | Moderate | 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 99476. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99476 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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