CPT code 99475: Pediatric critical care, initial day, ages 2–52026 Medicare rate & RVUs in New Mexico

In New Mexico, Medicare pays $472.26 for 99475 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99475 nationwide

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

What 99475 covers

This code covers the initial inpatient day of intensive physician care for a critically ill or injured child who is 2 through 5 years old. Typical situations include severe respiratory failure, septic shock, or major trauma requiring close assessment and active management of threatened vital functions. A pediatric intensivist or another physician providing critical care may report it in a pediatric intensive care unit or another inpatient setting when the child’s condition calls for that level of care; the unit’s name alone does not establish the service.

Select the code based on the child’s age and whether the service is the initial or a subsequent critical care day. The record should establish the child’s age, acute severity, critical care decisions and interventions, and the physician’s ongoing management of life-threatening instability. Report 99476 for a subsequent critical care day in this age group. CMS assigns work, practice-expense, and malpractice values to 99475 in the Physician Fee Schedule; the code’s payment is based on those schedule values and applicable claim circumstances.

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.

How New Mexico compares for 99475

Across 109 of 109 payment localities, the facility rate for 99475 runs from $452.30 in Arkansas to $656.55 in Alaska. New Mexico pays $472.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99475 rates by state

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

See 99475 in every payment locality

How the 99475 rate is calculated

Each of 99475’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 99475

99475 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.

Codes related to 99475

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

How 99475 has changed in New Mexico

Price 99475 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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