CPT code 99478: Infant intensive care, current weight under 1,500 grams2026 Medicare rate & RVUs in Missouri
Reports a subsequent day of intensive inpatient evaluation and management for a critically ill infant aged 29 days or older weighing under 1,500 grams.
CMS doesn’t publish an office rate for 99478 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $114.65 |
| Metropolitan St. Louis, MO | Unavailable | $115.03 |
| Rest of Missouri | Unavailable | $113.22 |
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.
How the rate is built · 99478
RVUs × geographic indexes × conversion factor
Work2.75
2.75 RVUs× 1.000 GPCI
Practice expense0.55
0.55 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
3.4700
Conversion factor
$33.4009
Medicare rate
$115.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99478
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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99478 isn’t priced in this setting.
99478 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99478 billing questions
Is the weight based on birth weight or current weight?
Use the infant’s current body weight for the date of service. Document the measured weight to support selection of the weight-based code.
How does 99478 differ from 99479?
99478 is for current weight under 1,500 grams; 99479 is for the next weight band, 1,500 to 2,500 grams.
Can both 99478 and another weight-band code be reported for the same day?
Select the single weight-band code that matches the patient’s current body weight for that date.
What supports reporting 99478?
The record should show the infant’s current weight and the evaluation, monitoring, interventions, and other care supporting intensive inpatient management that day.
How does 99478 differ from 99469?
99469 describes subsequent neonatal critical care for a neonate 28 days of age or younger. 99478 is a weight-based subsequent intensive-care service for an infant or young child aged 29 days or older.
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
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