Billing code 99476: Pediatric critical careMedicare rate & RVUs in Illinois
Reports a subsequent day of inpatient critical care management for a critically ill or injured patient who is 2 through 5 years old.
CMS doesn’t publish an office rate for 99476 in Illinois.
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 9 sections
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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $331.97 |
| East St. Louis | Unavailable | $319.92 |
| Rest Of Illinois | Unavailable | $311.19 |
| Suburban Chicago | Unavailable | $323.73 |
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.
How the rate is built · 99476
RVUs × geographic indexes × conversion factor
Work6.75
6.75 RVUs× 1.000 GPCI
Practice expense1.87
1.87 RVUs× 1.000 GPCI
Malpractice0.55
0.55 RVUs× 1.000 GPCI
Adjusted RVUs
9.1700
Conversion factor
$33.4009
Medicare rate
$306.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99476
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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99476 isn’t priced in this setting.
99476 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99475Pediatric critical care
- 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 care
- 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 care
- 99469 reports subsequent neonatal critical care. Use 99476 for subsequent-day critical care in a child ages 2 through 5.
99476 billing questions
When should 99476 be chosen instead of 99475?
Use 99475 for the initial day of pediatric critical care for a child ages 2 through 5. Use 99476 for a subsequent day of that care.
How does 99476 differ from 99472?
Both describe subsequent-day pediatric critical care, but 99472 is for patients 29 days through 24 months old. Code 99476 is for patients ages 2 through 5.
Is 99476 billed by time or by day?
It is a per-day service, not a time-based unit. The documentation should support the subsequent day of critical care management.
What documentation supports reporting 99476?
Document the patient’s age, critical illness or injury, and the intensive evaluation and management provided that day. The record should distinguish critical care management from routine inpatient follow-up.
Can 99476 be used for a newborn receiving intensive care?
No. Neonatal critical care has age-specific codes, including 99469 for subsequent neonatal critical care. Code 99476 is for children ages 2 through 5.
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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