CPT 99478 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 • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • FS - Split/shared E/M visit |
| Complexity Level | Low |
National average reimbursement for CPT 99478 by major payers:
$184.60
$175.06
$164.85
$223.17
| 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 99478 | ||||||
United | 99478 | $97.59 | 1023115615 - ALI PITAFI | 550477361 - (WV) BOONE MEMORIAL HOSPITAL INC | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $308.14 | 1881092385 - DEO MULINDWA | 550483245 - PRINCETON COMMUNITY HOSPITAL ASSN INC | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $156.83 | 1760633135 - YOU SUK CHOI | 471196863 - (TX) NATURES CHOICE MEDICAL CLINIC, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $217.05 | 1356788178 - CHARLES AMELEMAH | 845044935 - (TX) UNITY HOSPITALIST GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $126.02 | 1275590077 - DARIUS PEIKARI | 923465558 - VIRTUMED LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $104.90 | 1760700330 - NEUROPHYSIOLOGY | 461082525 - (TX) NEUROPHYSIOLOGY | TX | Neurology Physician (2084N0400X) |
United | 99478 | $122.04 | 1881639581 - BHUVANAPRASAD MANDALAPU | 204701276 | TX | Neurology Physician (2084N0400X) |
United | 99478 | $193.91 | 1407804594 - KATHERINE O'DONNELL | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99478 | $264.36 | 1407218282 - LILY PHAM | 521138284 - (MD) UNIVERSITY OF MARYLAND NEUROLOGY ASSOCIATES PA | TX | Neurology Physician (2084N0400X) |
United | 99478 | $181.89 | 1720083892 - MATTHEW MASIELLO | 251856569 - (PA) DUBOIS REGIONAL MEDICAL GROUP, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99478 | $181.58 | 1174810048 - MICHAEL GUTIERREZ | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $105.01 | 1164510392 - NEUROLOGY & NEUROPHYSIOLOGY, PA, NEURO-NEURO | 742939553 - (TX) NEUROLOGY NEUROPHYSIOLOGY PA | TX | Neurology Physician (2084N0400X) |
United | 99478 | $218.44 | 1124181342 - JULIE PAREKH | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99478 | $150.33 | 1689634073 - OMAR ALANI | 42619517 - (MA) WHITTIER STREET HEALTH CENTER COMMITTERE INC | MA | Pediatrics Physician (208000000X) |
United | 99478 | $231.05 | 1891750592 - ANGELO SERMAS | 742958277 - SCOTT & WHITE CLINIC | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 |
|---|---|---|
| 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 |
| 99469-CPT | Moderate | 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 | 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 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 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99478) and we'll show you how you compare in 15 minutes or less.