Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99477 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.
Init Day Hosp Neonate Care, Initial Hospital Care Per Day For The Evaluation And Management Of The Neonate 28 Days Of Age Or Younger Who Requires Intensive Observation Frequent Interventions And Other Intensive Care Services
| 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 | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $295.26 national non-facility rate (2026) · View Medicare rates for 99477 |
| Medicaid Fee Schedule | $244.63 median of the 8 states in the free preview · View Medicaid rates for 99477 |
National average reimbursement for CPT 99477 by major payers:
$439.67
$437.92
$417.37
$543.79
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99477.
CPT 99477
5 of 25 sample ratesHigher to lower in this preview
Candice Ho
$1,755.00Published rateSudha Russell
Valley Childrens Medical Group
$582.32Published rateAmjad Mahfoud
Glendora Pediatric Medical Group, Inc.
$379.48Published rateLoan Bui-Thompson
Valley Oak Pediatric Associates Medical Corporation
$325.70Published rateJaime Friedman
$28.01Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99477 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99477 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 99477 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 |
|---|---|---|
| 99468-CPT | High | Initial Inpatient Neonatal Cri, Initial Inpatient Neonatal Critical Care Per Dayfor The Evaluation And Management Of A Critically Ill Neonate 28 Days Of Age Or Younger |
| 99469-CPT | Moderate | Subsequent Inpatient Neonatal, Subsequent Inpatient Neonatal Critical Care Per Day For The Evaluation And Management Of A Critically Ill Neonate 28 Days Of Age Or Younger |
| 99477-CPT | Moderate | Init Day Hosp Neonate Care, Initial Hospital Care Per Day For The Evaluation And Management Of The Neonate 28 Days Of Age Or Younger Who Requires Intensive Observation Frequent Interventions And Other Intensive Care Services |
| 99478-CPT | Low | Subsequent Intensive Care Per, Subsequent Intensive Care Per Day For The Evaluation And Management Of The Recovering Very Low Birth Weight Infant (Present Body Weight Less Than 1500 Grams) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99477. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99477 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99477) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
CPT 99477 reports initial hospital care, per day, for a neonate 28 days or younger who needs intensive observation, frequent interventions and other intensive care services, but is not critically ill.
A critically ill neonate is reported with the initial neonatal critical care code 99468. CPT 99477 covers intensive care without critical illness.
Medicare pays CPT 99477 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 99477 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.