CPT code 99476: Pediatric critical care, ages 2–5, subsequent day2026 Medicare rate & RVUs

Medicare pays $306.29 for 99476 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 99476 covers

This code describes a subsequent day of intensive physician management for a critically ill or critically injured child ages 2 through 5. It is typically reported by a pediatric intensivist or another physician managing the child in an inpatient critical care setting, such as a pediatric intensive care unit. Examples of conditions requiring this level of care include respiratory failure or shock when the child needs active, intensive management.

Report the subsequent-day service after the initial day of pediatric critical care; use the age-specific initial-day code for ages 2 through 5 on the initial day. The record should support the child’s age, critical illness or injury, and the evaluation and management performed that day, including the ongoing problems addressed and treatment decisions. This is a per-day service, so report it for the documented subsequent day rather than as a time-based unit. The record should also make clear that the service was critical care, rather than routine inpatient follow-up.

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 99476 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

99476 rates by state

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

How the 99476 rate is calculated

Each of 99476’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 99476

99476 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.

99476 compared with similar codes

How to choose

99475Pediatric critical careInitial day, ages 2–5

Both codes are for pediatric critical care in patients ages 2 through 5. Choose 99475 for the initial day and 99476 for a subsequent day.

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

This is the subsequent-day counterpart for pediatric critical care in patients 29 days through 24 months; 99476 applies to ages 2 through 5.

99469Neonatal critical careSubsequent day

99469 reports subsequent neonatal critical care. Use 99476 for subsequent-day critical care in a child ages 2 through 5.

Codes related to 99476

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