CPT 99485 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 • 23 - Emergency Room |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 99485 by major payers:
$98.19
$96.80
$85.11
$127.01
| 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 99485 | ||||||
United | 99485 | $76.65 | 1093923948 - HC MEDICAL DOCTORS, P.A. | 200187041 - (TX) HC MEDICAL DOCTORS P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $55.90 | 1619164852 - YOLANDA AJALA | 452209444 | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $197.80 | 1275521197 - CHILDS ART | 42772469 - (MA) NORTHERN BERKSHIRE PEDIATRICS, LLP | MA | Pediatrics Physician (208000000X) |
United | 99485 | $116.06 | 1538116736 - ANEES OMAR | 260459246 - (TX) A JAVED OMAR MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $75.34 | 1104184753 - FAUSTINA DONKOR | 922465140 | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $107.59 | 1790131886 - DAVID BOONE | 760459500 - U T PHYSICIANS | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99485 | $157.49 | 1730164252 - IRAM HAMDARD | 205382325 - (TX) DFW PROMPT CARE | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $199.22 | 1700871845 - ERIN MCMASTER | 42911067 - UMASS MEMORIAL HEALTH CARE INC | MA | Pediatrics Physician (208000000X) |
United | 99485 | $197.80 | 1750596201 - NORTHERN BERKSHIRE PEDIATRICS, LLP | 42772469 - (MA) NORTHERN BERKSHIRE PEDIATRICS, LLP | MA | Pediatrics Physician (208000000X) |
United | 99485 | $254.82 | 1982950218 - SARWAT KHALIL | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $157.49 | 1689171472 - BUSH BENJAMIN | 842188069 - (TX) INSPIRE HEALTH PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $71.13 | 1477812477 - SONAL PATEL | 934473770 - (TX) HHA HOSPITAL MEDICINE OF TEXAS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $119.43 | 1740784727 - INSIA HASHMI | 300520570 - (TX) METHODIST HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99485 | $180.57 | 1457642647 - GEORGE ADESINA | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99485 | $210.25 | 1174977177 - SHIV MOHINI | 910851599 - THE VANCOUVER CLINIC, INC., PS | TX | Internal Medicine Physician (207R00000X) |
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 99485 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99485 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 99485 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) |
| 99467-CPT | Low | Critical Care Face-To-Face Services During An Interfacility Transoport Of Critically Ill Or Critically Injured Pediatric Patient 24 Months Ofage Or Younger; Each Additional 30 Minutes (List Separately In Addition To Code For Primary Service) (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 |
| 99485-CPT | Low | Supervision By A Control Physician Of Inter- Facility Transport Care Of The Critically Ill Or Critically Injured Pediatric Patient 24 Months Of Age Or Younger Includes Two-Way Communication With Transport Team Before Transportat The Referring Facility And During The Transportincluding Data Interpretation And Report; First 30minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99485. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99485 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 99485) and we'll show you how you compare in 15 minutes or less.