No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
99476 Pediatric critical care Medicare reimbursement rates in Iowa
Reports a subsequent day of inpatient critical care management for a critically ill or injured patient who is 2 through 5 years old. Compare 99476 office and facility rates across CMS payment localities in Iowa.
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.
What does Medicare pay for 99476 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$289.90
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Pediatric critical care
About 99476: Subsequent pediatric critical care, ages 2–5
Reports a subsequent day of inpatient critical care management for a critically ill or injured patient who is 2 through 5 years old.
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.
Where the value comes from
- Work RVU6.75 · 74%
- Practice expense (office) RVU1.87 · 20%
- Malpractice RVU0.55 · 6%
313
Medicare services in 2024 · #3966 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.
99476 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
This is the subsequent-day counterpart for pediatric critical care in patients 29 days through 24 months; 99476 applies to ages 2 through 5.
No office rate
99469 reports subsequent neonatal critical care. Use 99476 for subsequent-day critical care in a child ages 2 through 5.
Compare 99476 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Iowa →
Office / nonfacility
Unavailable
Facility
$289.90
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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 99476 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
13,143
- Code
- 99476
- Physician work
- 6.75
- Practice expense
- 1.87
- Malpractice
- 0.55
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.75 | × 1.000 | 6.7500 |
| Practice expense | 1.87 | × 0.915 | 1.7111 |
| Malpractice | 0.55 | × 0.397 | 0.2184 |
| Total RVUs | 8.6794 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$289.90
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.75 | 1 |
| Practice expense | 1.87 | 0.915 |
| Malpractice | 0.55 | 0.397 |
(6.75 × 1 + 1.87 × 0.915 + 0.55 × 0.397) × $33.4009 = $289.90
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.
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 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.
13,14099473,,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
13,14399476,,Ped crit care age 2-5 subsq,A,,6.75,1.87,NA,1.87,,0.55,9.17,9.17,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14499477,,Init day hosp neonate care,A,,7.00,1.41,NA,1.41,,0.43,8.84,8.84,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14599478,,"Sbsq ic vlbw inf<1,500 gm",A,,2.75,0.55,NA,0.55,,0.17,3.47,3.47,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14699479,,"Sbsq ic lbw inf 1,500-2,500",A,,2.50,0.50,NA,0.50,,0.15,3.15,3.15,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136