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See a sample rate comparisonCPT 99480 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.
Medical Care, Subsequent Intensive Care Per Day For The Evaluation And Management Of The Recovering Very Low Birth Weight Infant (Present Body Weight Of 2501-5000 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 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | $101.21 national non-facility rate (2026) · View Medicare rates for 99480 |
| Medicaid Fee Schedule | $95.07 median of the 8 states in the free preview · View Medicaid rates for 99480 |
National average reimbursement for CPT 99480 by major payers:
$157.47
$152.44
$144.52
$194.86
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CPT 99480
5 of 25 sample ratesHigher to lower in this preview
Paola Cota Phelan
$689.60Published rateMegan Foley
Sutter Bay Medical Foundation
$411.13Published ratePhilip Meyers
Children'S Clinic, P.A.
$187.92Published rateDavid King
Children'S Medical Group, P.C.
$149.80Published rateRomit Kar
Romit Kumar Kar, M.D.,Dba Kar'S Pediatrics
$90.98Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99480 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99480 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 99480 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) |
| 99480-CPT | Low | Medical Care, Subsequent Intensive Care Per Day For The Evaluation And Management Of The Recovering Very Low Birth Weight Infant (Present Body Weight Of 2501-5000 Grams) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99480. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99480 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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Frequently Asked Questions
Finding the exact cost of a medical procedure can be complex due to varying factors like insurance coverage, provider rates, and geographic location. For specific pricing information based on CPT codes and your location, you can utilize tools like Payerprice. It's also recommended to contact your healthcare provider's billing department and your insurance company directly for estimates.
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, healthcare providers, and payers to describe medical, surgical, and diagnostic services. They are crucial for accurate billing and processing of claims for reimbursement.
A fee schedule is a comprehensive list of fees used by health plans to pay doctors and other providers. It specifies the maximum amount that will be paid for a specific service or procedure. Fee schedules are often structured around CPT codes.
For specific pricing information based on CPT codes and your location, it is recommended to use a tool like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get relevant pricing data tailored to your needs.
CMS (Centers for Medicare & Medicaid Services) provides data and fee schedules primarily for Medicare and Medicaid services. While this data can serve as a reference, it may not reflect commercial insurance rates or self-pay rates and can be complex to interpret for individual procedures. Payerprice, on the other hand, offers a more generalized fee schedule lookup tool. It allows users to search with CPT codes and specific locations, often providing a broader range of pricing data relevant to commercial plans and a wider audience, making it more suitable for individual users seeking specific, actionable pricing information beyond just Medicare rates.