No office rate
99471 covers the initial 24-hour period of pediatric critical care for children aged 29 days through 24 months; 99472 is for subsequent days.
On this page
CMS RVU26D · Effective 2026-10-01
99472 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$353.54
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Pediatric critical care
About 99472: Subsequent critical care for infant
Report 99472 for a subsequent day of critical care management for a critically ill infant or young child aged 29 days through 24 months.
Code 99472 represents a subsequent day of critical care for a critically ill child aged 29 days through 24 months. Pediatric intensivists, hospitalists, and other physicians may provide this care in an ICU or another setting equipped to manage an immediately threatening condition. Examples include acute respiratory failure, septic shock, or severe cardiac instability when the child needs high-complexity decisions to prevent or manage deterioration in a vital organ system.
Select 99472 for a subsequent day, not the initial 24-hour period; use 99471 for that initial period. The record should support the child’s age, critical illness, threatened organ function, and the physician’s high-complexity management on the billed day. This is a daily service, not a code selected by adding up minutes. Routine assessment and management integral to that day’s critical care are part of the service rather than a separate E/M service for the same work.
Where the value comes from
- Work RVU7.99 · 76%
- Practice expense (office) RVU1.96 · 19%
- Malpractice RVU0.58 · 6%
206
Medicare services in 2024 · #4305 by national volume
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.
99472 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
99469 is the subsequent-day neonatal critical care code. Choose based on the patient’s age group, not simply the similarity of the critical-care service.
No office rate
99476 covers subsequent-day pediatric critical care for children ages 2 through 5 years; 99472 covers ages 29 days through 24 months.
The same code, a different location
How does Modesto compare?
99472 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Merced
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Napa
California · 99472
Office
Unavailable
Facility
$379.81
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 99472
Office
Unavailable
Facility
$363.80
No comparable office rate is available.
Redding
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Rest Of California
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 99472
Office
Unavailable
Facility
$359.95
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 99472
Office
Unavailable
Facility
$363.00
No comparable office rate is available.
Salinas
California · 99472
Office
Unavailable
Facility
$361.40
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 99472
Office
Unavailable
Facility
$363.68
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 99472
Office
Unavailable
Facility
$393.42
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 99472
Office
Unavailable
Facility
$392.77
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 99472
Office
Unavailable
Facility
$401.01
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 99472
Office
Unavailable
Facility
$398.32
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 99472
Office
Unavailable
Facility
$356.36
No comparable office rate is available.
Santa Cruz-Watsonville
California · 99472
Office
Unavailable
Facility
$362.40
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 99472
Office
Unavailable
Facility
$361.06
No comparable office rate is available.
Santa Rosa-Petaluma
California · 99472
Office
Unavailable
Facility
$365.66
No comparable office rate is available.
Stockton
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Vallejo
California · 99472
Office
Unavailable
Facility
$378.86
No comparable office rate is available.
Visalia
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Yuba City
California · 99472
Office
Unavailable
Facility
$353.54
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 99472
Office
Unavailable
Facility
$379.96
No comparable office rate is available.
Miami
Florida · 99472
Office
Unavailable
Facility
$384.02
No comparable office rate is available.
Chicago
Illinois · 99472
Office
Unavailable
Facility
$378.99
No comparable office rate is available.
Manhattan
New York · 99472
Office
Unavailable
Facility
$390.75
No comparable office rate is available.
Alaska*
Alaska · 99472
Office
Unavailable
Facility
$480.71
No comparable office rate is available.
Alabama
Alabama · 99472
Office
Unavailable
Facility
$335.12
No comparable office rate is available.
Arkansas
Arkansas · 99472
Office
Unavailable
Facility
$333.09
No comparable office rate is available.
Arizona
Arizona · 99472
Office
Unavailable
Facility
$346.89
No comparable office rate is available.
Colorado
Colorado · 99472
Office
Unavailable
Facility
$354.86
No comparable office rate is available.
Connecticut
Connecticut · 99472
Office
Unavailable
Facility
$366.16
No comparable office rate is available.
Delaware
Delaware · 99472
Office
Unavailable
Facility
$350.30
No comparable office rate is available.
Fort Lauderdale
Florida · 99472
Office
Unavailable
Facility
$368.22
No comparable office rate is available.
Rest Of Florida
Florida · 99472
Office
Unavailable
Facility
$358.58
No comparable office rate is available.
Atlanta
Georgia · 99472
Office
Unavailable
Facility
$357.45
No comparable office rate is available.
Rest Of Georgia
Georgia · 99472
Office
Unavailable
Facility
$348.36
No comparable office rate is available.
Hawaii, Guam
Hawaii · 99472
Office
Unavailable
Facility
$352.52
No comparable office rate is available.
Iowa
Iowa · 99472
Office
Unavailable
Facility
$334.47
No comparable office rate is available.
Idaho
Idaho · 99472
Office
Unavailable
Facility
$336.26
No comparable office rate is available.
East St. Louis
Illinois · 99472
Office
Unavailable
Facility
$366.12
No comparable office rate is available.
Rest Of Illinois
Illinois · 99472
Office
Unavailable
Facility
$356.92
No comparable office rate is available.
Suburban Chicago
Illinois · 99472
Office
Unavailable
Facility
$370.30
No comparable office rate is available.
Indiana
Indiana · 99472
Office
Unavailable
Facility
$336.97
No comparable office rate is available.
Kansas
Kansas · 99472
Office
Unavailable
Facility
$335.82
No comparable office rate is available.
Kentucky
Kentucky · 99472
Office
Unavailable
Facility
$342.80
No comparable office rate is available.
New Orleans
Louisiana · 99472
Office
Unavailable
Facility
$350.48
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 99472
Office
Unavailable
Facility
$343.37
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 99472
Office
Unavailable
Facility
$373.22
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 99472
Office
Unavailable
Facility
$355.52
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 99472
Office
Unavailable
Facility
$365.35
No comparable office rate is available.
Rest Of Maryland
Maryland · 99472
Office
Unavailable
Facility
$353.58
No comparable office rate is available.
Rest Of Maine
Maine · 99472
Office
Unavailable
Facility
$339.15
No comparable office rate is available.
Southern Maine
Maine · 99472
Office
Unavailable
Facility
$343.97
No comparable office rate is available.
Detroit
Michigan · 99472
Office
Unavailable
Facility
$362.71
No comparable office rate is available.
Rest Of Michigan
Michigan · 99472
Office
Unavailable
Facility
$348.52
No comparable office rate is available.
Minnesota
Minnesota · 99472
Office
Unavailable
Facility
$339.97
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 99472
Office
Unavailable
Facility
$347.27
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 99472
Office
Unavailable
Facility
$348.61
No comparable office rate is available.
Rest Of Missouri
Missouri · 99472
Office
Unavailable
Facility
$342.17
No comparable office rate is available.
Mississippi
Mississippi · 99472
Office
Unavailable
Facility
$337.56
No comparable office rate is available.
Montana**
Montana · 99472
Office
Unavailable
Facility
$351.67
No comparable office rate is available.
North Carolina
North Carolina · 99472
Office
Unavailable
Facility
$340.33
No comparable office rate is available.
North Dakota**
North Dakota · 99472
Office
Unavailable
Facility
$340.20
No comparable office rate is available.
Nebraska
Nebraska · 99472
Office
Unavailable
Facility
$334.62
No comparable office rate is available.
New Hampshire
New Hampshire · 99472
Office
Unavailable
Facility
$351.97
No comparable office rate is available.
Northern Nj
New Jersey · 99472
Office
Unavailable
Facility
$380.32
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 99472
Office
Unavailable
Facility
$370.29
No comparable office rate is available.
New Mexico
New Mexico · 99472
Office
Unavailable
Facility
$350.17
No comparable office rate is available.
Nevada**
Nevada · 99472
Office
Unavailable
Facility
$348.54
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 99472
Office
Unavailable
Facility
$397.77
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 99472
Office
Unavailable
Facility
$374.01
No comparable office rate is available.
Queens
New York · 99472
Office
Unavailable
Facility
$389.27
No comparable office rate is available.
Rest Of New York
New York · 99472
Office
Unavailable
Facility
$342.68
No comparable office rate is available.
Ohio
Ohio · 99472
Office
Unavailable
Facility
$346.17
No comparable office rate is available.
Oklahoma
Oklahoma · 99472
Office
Unavailable
Facility
$340.39
No comparable office rate is available.
Portland
Oregon · 99472
Office
Unavailable
Facility
$358.29
No comparable office rate is available.
Rest Of Oregon
Oregon · 99472
Office
Unavailable
Facility
$345.70
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 99472
Office
Unavailable
Facility
$362.94
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 99472
Office
Unavailable
Facility
$345.28
No comparable office rate is available.
Puerto Rico
Puerto Rico · 99472
Office
Unavailable
Facility
$352.14
No comparable office rate is available.
Rhode Island
Rhode Island · 99472
Office
Unavailable
Facility
$356.85
No comparable office rate is available.
South Carolina
South Carolina · 99472
Office
Unavailable
Facility
$343.83
No comparable office rate is available.
South Dakota**
South Dakota · 99472
Office
Unavailable
Facility
$338.85
No comparable office rate is available.
Tennessee
Tennessee · 99472
Office
Unavailable
Facility
$336.78
No comparable office rate is available.
Austin
Texas · 99472
Office
Unavailable
Facility
$353.83
No comparable office rate is available.
Beaumont
Texas · 99472
Office
Unavailable
Facility
$344.44
No comparable office rate is available.
Brazoria
Texas · 99472
Office
Unavailable
Facility
$349.00
No comparable office rate is available.
Dallas
Texas · 99472
Office
Unavailable
Facility
$351.10
No comparable office rate is available.
Fort Worth
Texas · 99472
Office
Unavailable
Facility
$350.70
No comparable office rate is available.
Galveston
Texas · 99472
Office
Unavailable
Facility
$350.06
No comparable office rate is available.
Houston
Texas · 99472
Office
Unavailable
Facility
$360.67
No comparable office rate is available.
Rest Of Texas
Texas · 99472
Office
Unavailable
Facility
$346.49
No comparable office rate is available.
Utah
Utah · 99472
Office
Unavailable
Facility
$345.81
No comparable office rate is available.
Virginia
Virginia · 99472
Office
Unavailable
Facility
$344.90
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 99472
Office
Unavailable
Facility
$352.14
No comparable office rate is available.
Vermont
Vermont · 99472
Office
Unavailable
Facility
$341.49
No comparable office rate is available.
Rest Of Washington
Washington · 99472
Office
Unavailable
Facility
$354.02
No comparable office rate is available.
Seattle (King Cnty)
Washington · 99472
Office
Unavailable
Facility
$376.37
No comparable office rate is available.
Wisconsin
Wisconsin · 99472
Office
Unavailable
Facility
$335.56
No comparable office rate is available.
West Virginia
West Virginia · 99472
Office
Unavailable
Facility
$351.49
No comparable office rate is available.
Wyoming**
Wyoming · 99472
Office
Unavailable
Facility
$346.67
No comparable office rate is available.
See how rates vary across the country
99472 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 99472 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$388.89
$353.54 × 110% = $388.89
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99472 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
13,139
- Code
- 99472
- Physician work
- 7.99
- Practice expense
- 1.96
- Malpractice
- 0.58
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.99 | × 1.017 | 8.1258 |
| Practice expense | 1.96 | × 1.096 | 2.1482 |
| Malpractice | 0.58 | × 0.536 | 0.3109 |
| Total RVUs | 10.5849 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$353.54
Open 99472 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.99 | 1.017 |
| Practice expense | 1.96 | 1.096 |
| Malpractice | 0.58 | 0.536 |
(7.99 × 1.017 + 1.96 × 1.096 + 0.58 × 0.536) × $33.4009 = $353.54
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
99472 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $353.54 | RVU26D |
| 2026-07-01 | Not available in this setting | $353.54 | RVU26C |
| 2026-04-01 | Not available in this setting | $353.54 | RVU26B |
| 2026-01-01 | Not available in this setting | $353.54 | RVU26A |
| 2025-10-01 | Not available in this setting | $385.10 | RVU25D |
| 2025-07-01 | Not available in this setting | $385.10 | RVU25C |
| 2025-04-01 | Not available in this setting | $385.10 | RVU25B |
| 2025-01-01 | Not available in this setting | $385.10 | RVU25A |
99472 billing questions
When should 99472 be used instead of 99471?
Use 99471 for the initial 24-hour period of pediatric critical care in this age group. Use 99472 for each subsequent day of qualifying critical care.
Does the child have to be in an ICU?
No. The setting alone does not determine code selection; the child must meet the critical-care criteria and receive the required high-complexity management.
Is 99472 based on a number of minutes?
No. It represents a subsequent day of care, rather than a timed increment. Document the critical-care service provided on that day.
Can routine inpatient follow-up be reported as 99472?
No. The child must remain critically ill and require critical-care management; routine daily hospital care alone does not support this code.
What documentation supports 99472?
Document the child’s age, the critical condition and threatened organ function, and the high-complexity assessment and management performed on the subsequent day.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,13699469,,Neonate crit care subsq,A,,7.99,1.61,NA,1.61,,0.48,10.08,10.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13799470,,Rpm tx mgmt 1st 10 min,A,,0.31,0.45,,0.07,,0.02,0.78,0.40,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13899471,,Ped critical care initial,A,,15.98,3.22,NA,3.22,,0.99,20.19,20.19,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13999472,,Ped critical care subsq,A,,7.99,1.96,NA,1.96,,0.58,10.53,10.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14099473,,Self-meas bp pt educaj/train,A,,0.00,0.45,,0.45,NA,0.01,0.46,0.46,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14199474,,Self-meas bp 2 readg bid 30d,A,,0.18,0.36,,0.05,,0.01,0.55,0.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14299475,,Ped crit care age 2-5 init,A,,11.25,2.26,NA,2.26,,0.68,14.19,14.19,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536