CPT 99486 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 • 25 - Significant, separately identifiable E/M service same day • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 99486 by major payers:
$88.23
$84.34
$71.32
$111.33
| 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 99486 | ||||||
United | 99486 | $101.62 | 1992978910 - ILEVBA OSARENKHOE | 452525763 - (MD) MDICS AT CIVISTA LLC | MA | Pediatrics Physician (208000000X) |
United | 99486 | $113.40 | 1023286317 - KAI SUN | 752600873 - (TX) SHANNON CLINIC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99486 | $170.44 | 1487185773 - ABENA HAGAN-BROWN | 43148394 - (MA) TUFTS MEDICAL CENTER PHYSICIANS ORGANIZATION INC | MA | Pediatrics Physician (208000000X) |
United | 99486 | $172.33 | 1447341581 - ANNA WARD | 42730094 - (MA) WAREHAM PEDIATRIC ASSOCIATES, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99486 | $170.44 | 1609213750 - LEELA SARATHY | 43148394 - (MA) TUFTS MEDICAL CENTER PHYSICIANS ORGANIZATION INC | MA | Pediatrics Physician (208000000X) |
United | 99486 | $55.13 | 1841389020 - MANSOORA SHEIKH | 260233069 - (TX) MANSOORA A SHEIKH MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $137.16 | 1902288020 - NICOLE JOHNSON | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $125.41 | 1710543574 - BRANDON PARKER | 430653611 - WASHINGTON UNIVERSITY | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $90.87 | 1972983336 - JOSE MOONJELY DAVIS | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $149.94 | 1841281250 - SARAH ANDREW | 43128789 - (MA) WILMINGTON PEDIATRICS, INC. | MA | Pediatrics Physician (208000000X) |
United | 99486 | $92.76 | 1760579155 - SOUKAINA ADOLPHE | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99486 | $95.08 | 1598099327 - ILYAS KHAN | 760458535 - BAYLOR ST LUKES MEDICAL GROUP | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99486 | $82.23 | 1609824184 - MYTHILI VEDALA | 471896723 - (TX) ANAMAYA INTERNAL MEDICINE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $95.50 | 1477948172 - KRUTI PATEL | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Internal Medicine Physician (207R00000X) |
United | 99486 | $131.17 | 1356369763 - MATTHEW BENZ | 42472266 - (MA) RELIANT MEDICAL GROUP, INC. | MA | Pediatrics Physician (208000000X) |
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 |
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CPT 99486 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99486 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 99486 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 |
| 99486-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; Each Additional 30 Minutes (List Separately In Additionto Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99486. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99486 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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