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See a sample rate comparisonCPT 99478 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.
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)
| 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 | GC - Service performed by resident under supervision FS - Split/shared E/M visit |
| Complexity Level | Low |
| Medicare Fee Schedule | $115.90 national non-facility rate (2026) · View Medicare rates for 99478 |
| Medicaid Fee Schedule | $108.795 median of the 8 states in the free preview · View Medicaid rates for 99478 |
National average reimbursement for CPT 99478 by major payers:
$184.60
$175.06
$164.85
$223.33
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CPT 99478
5 of 25 sample ratesHigher to lower in this preview
Shyamala Miryala
Texas Health Physicians Group
$452.58Published rateAngelo Sermas
Scott & White Clinic
$231.05Published rateBrad Snodgrass
Covenant Medical Group
$182.03Published ratePrimary Care Internal Medicine PLLC, Mark Doerner Sole Mbr
Primary Care Internal Medicine PLLC
$138.19Published rateAli Pitafi
Boone Memorial Hospital Inc
$97.59Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99478 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99478 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 99478 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 |
|---|---|---|
| 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) |
| 99479-CPT | Low | Subsequent Intensive Care Per, Subsequent Intensive Care Per Day For The Evaluation And Management Of The Recovering Low Birth Weight Infant (Present Body Weight Of 1500-2500 Grams) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99478. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99478 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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