CPT code 99475: Pediatric critical care, initial day, ages 2–52026 Medicare rate & RVUs in Combine, Texas
CPT 99475: $467.91–$473.81 facility across 2 localities in Combine, TX in 2026 Medicare. Compare each area.
CMS doesn’t publish an office rate for 99475 in Combine, Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 99475 pays more and less in Combine, Texas
Combine, Texas maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Dallas, TX | Unavailable | $473.81 |
| Rest of Texas | Unavailable | $467.91 |
How payment areas work in Combine
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Dallas · Dallas County
- Rest Of State · Kaufman County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
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.
How the rate is built · 99475
RVUs × geographic indexes × conversion factor
Work11.25
11.25 RVUs× 1.000 GPCI
Practice expense2.26
2.26 RVUs× 1.000 GPCI
Malpractice0.68
0.68 RVUs× 1.000 GPCI
Adjusted RVUs
14.1900
Conversion factor
$33.4009
Medicare rate
$473.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99475
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99475 isn’t priced in this setting.
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 99475 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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