No office rate
Use 99478 below 1,500 grams current weight and 99479 from 1,500 through 2,500 grams.
On this page
CMS RVU26D · Effective 2026-10-01
99478 Infant intensive care Medicare reimbursement rates in Iowa
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. Compare 99478 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 99478 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
$110.92
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.
Neonatal care
About 99478: Subsequent intensive care, very low weight infant
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.
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. The CMS facts provided list no additional payment rules for this code.
Where the value comes from
- Work RVU2.75 · 79%
- Practice expense (office) RVU0.55 · 16%
- Malpractice RVU0.17 · 5%
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.
99478 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
99480 covers the higher current-weight band, 2,501 through 5,000 grams; 99478 is for weight under 1,500 grams.
No office rate
99477 describes initial hospital-day care for a neonate. 99478 is subsequent intensive care selected by the patient’s current weight.
No office rate
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.
Compare 99478 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
$110.92
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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 99478 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
13,145
- Code
- 99478
- Physician work
- 2.75
- Practice expense
- 0.55
- Malpractice
- 0.17
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.75 | × 1.000 | 2.7500 |
| Practice expense | 0.55 | × 0.915 | 0.5033 |
| Malpractice | 0.17 | × 0.397 | 0.0675 |
| Total RVUs | 3.3207 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$110.92
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.75 | 1 |
| Practice expense | 0.55 | 0.915 |
| Malpractice | 0.17 | 0.397 |
(2.75 × 1 + 0.55 × 0.915 + 0.17 × 0.397) × $33.4009 = $110.92
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.
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 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.
13,14299475,,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
13,14799480,,"Sbsq ic inf pbw 2,501-5,000",A,,2.40,0.48,NA,0.48,,0.15,3.03,3.03,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,14899483,,Assmt & care pln pt cog imp,A,,3.84,4.66,,0.97,,0.27,8.77,5.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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