CPT code 99472: Pediatric critical care, subsequent day, ages 29 days–24 months2026 Medicare rate & RVUs

Medicare pays $351.71 for 99472 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 99472 covers

Code 99472 represents a subsequent day of critical care for a critically ill child aged 29 days through 24 months. Pediatric intensivists, hospitalists, and other physicians may provide this care in an ICU or another setting equipped to manage an immediately threatening condition. Examples include acute respiratory failure, septic shock, or severe cardiac instability when the child needs high-complexity decisions to prevent or manage deterioration in a vital organ system.

Select 99472 for a subsequent day, not the initial 24-hour period; use 99471 for that initial period. The record should support the child’s age, critical illness, threatened organ function, and the physician’s high-complexity management on the billed day. This is a daily service, not a code selected by adding up minutes. Routine assessment and management integral to that day’s critical care are part of the service rather than a separate E/M service for the same work.

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 99472 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

99472 rates by state

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

How the 99472 rate is calculated

Each of 99472’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 99472

99472 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.

99472 compared with similar codes

How to choose

99471Pediatric critical careInitial day, age 29 days–24 months

99471 covers the initial 24-hour period of pediatric critical care for children aged 29 days through 24 months; 99472 is for subsequent days.

99469Neonatal critical careSubsequent day

99469 is the subsequent-day neonatal critical care code. Choose based on the patient’s age group, not simply the similarity of the critical-care service.

99476Pediatric critical careAges 2–5, subsequent day

99476 covers subsequent-day pediatric critical care for children ages 2 through 5 years; 99472 covers ages 29 days through 24 months.

Codes related to 99472

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