CPT code 99471: Pediatric critical care, initial day, age 29 days–24 months2026 Medicare rate & RVUs

Medicare pays $674.36 for 99471 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99471 covers

99471 represents the initial day of inpatient critical care management for an infant aged 29 days through 24 months whose illness or injury requires intensive physician evaluation and management. It is typically reported by a pediatric intensivist or another physician managing a critically ill infant in a pediatric intensive care unit. Examples of situations may include severe respiratory failure or circulatory instability requiring intensive management; routine inpatient care for a stable infant is not the service described by this code.

Report the code for the initial day of critical care in this age group, rather than for a subsequent day. Documentation should establish the infant’s age, critical illness or injury, the intensive evaluation and management provided, and that this is the initial day. Use the age-appropriate neonatal or older-child code when the patient falls outside this code’s age range.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99471 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99471 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99471 rate is calculated

Each of 99471’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99471

99471 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99471 compared with similar codes

How to choose

99472Pediatric critical careSubsequent day, ages 29 days–24 months

Use 99471 for the initial day of critical care in this infant age group; use 99472 for subsequent days.

99468Neonatal critical careInitial day

99468 is the initial-day neonatal critical care code. 99471 is for infants beginning at 29 days of age.

99475Pediatric critical careInitial day, ages 2–5

99475 covers initial-day critical care for children aged 2 through 5 years; 99471 is for the younger infant group.

99466Critical care transportAge 24 months or younger

99466 describes pediatric critical care during transport. 99471 is for initial-day inpatient critical care management.

Codes related to 99471

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates