CPT code 99478: Infant intensive care, current weight under 1,500 grams2026 Medicare rate & RVUs

Medicare pays $115.90 for 99478 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 99478 covers

Code 99478 describes a subsequent day of intensive evaluation and management for a critically ill infant or young child aged 29 days or older whose current body weight is under 1,500 grams. It is typically reported by a neonatologist or pediatrician providing ongoing care in a neonatal or pediatric intensive care setting, where the infant needs intensive observation, frequent interventions, and other intensive services.

Select the code using the patient’s current body weight for the date of service, not birth weight; document that weight and the clinical work supporting intensive care. Report one daily service when the patient meets this code’s weight and care criteria. The 1,500-gram threshold distinguishes this service from the adjacent weight-based subsequent-care codes.

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 99478 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

99478 rates by state

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

How the 99478 rate is calculated

Each of 99478’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 99478

99478 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.

99478 compared with similar codes

How to choose

99479Neonatal intensive care1,500–2,500 grams

Use 99478 below 1,500 grams current weight and 99479 from 1,500 through 2,500 grams.

99480Infant intensive care2,501–5,000 grams

99480 covers the higher current-weight band, 2,501 through 5,000 grams; 99478 is for weight under 1,500 grams.

99477Neonatal careInitial intensive-care day

99477 describes initial hospital-day care for a neonate. 99478 is subsequent intensive care selected by the patient’s current weight.

99469Neonatal critical careSubsequent day

99469 is for subsequent neonatal critical care through 28 days of age; 99478 is weight-based subsequent intensive care for patients aged 29 days or older.

Codes related to 99478

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