No office rate
Use 99471 for the initial day of critical care in this infant age group; use 99472 for subsequent days.
On this page
CMS RVU26D · Effective 2026-10-01
99471 Pediatric critical care Medicare reimbursement rates in Kansas
Reports the initial day of inpatient critical care management for a critically ill or injured infant from 29 days through 24 months of age. Compare 99471 office and facility rates across CMS payment localities in Kansas.
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 99471 in Kansas?
Kansas 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
$647.64
1 of 1 localities have a supported rate.
Payment area: Kansas
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 99471: Initial pediatric critical care, infant
Reports the initial day of inpatient critical care management for a critically ill or injured infant from 29 days through 24 months of age.
99471 represents the initial day of inpatient critical care management for an infant aged 29 days through 24 months whose illness or injury requires intensive physician evaluation and management. It is typically reported by a pediatric intensivist or another physician managing a critically ill infant in a pediatric intensive care unit. Examples of situations may include severe respiratory failure or circulatory instability requiring intensive management; routine inpatient care for a stable infant is not the service described by this code.
Report the code for the initial day of critical care in this age group, rather than for a subsequent day. Documentation should establish the infant’s age, critical illness or injury, the intensive evaluation and management provided, and that this is the initial day. Use the age-appropriate neonatal or older-child code when the patient falls outside this code’s age range. CMS lists no additional payment rules for this code in the supplied facts.
Where the value comes from
- Work RVU15.98 · 79%
- Practice expense (office) RVU3.22 · 16%
- Malpractice RVU0.99 · 5%
15
Medicare services in 2024 · #6086 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.
99471 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
99468 is the initial-day neonatal critical care code. 99471 is for infants beginning at 29 days of age.
No office rate
99475 covers initial-day critical care for children aged 2 through 5 years; 99471 is for the younger infant group.
No office rate
99466 describes pediatric critical care during transport. 99471 is for initial-day inpatient critical care management.
Compare 99471 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
Kansas →
Office / nonfacility
Unavailable
Facility
$647.64
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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 99471 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
13,138
- Code
- 99471
- Physician work
- 15.98
- Practice expense
- 3.22
- Malpractice
- 0.99
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.98 | × 1.000 | 15.9800 |
| Practice expense | 3.22 | × 0.904 | 2.9109 |
| Malpractice | 0.99 | × 0.504 | 0.4990 |
| Total RVUs | 19.3898 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$647.64
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.98 | 1 |
| Practice expense | 3.22 | 0.904 |
| Malpractice | 0.99 | 0.504 |
(15.98 × 1 + 3.22 × 0.904 + 0.99 × 0.504) × $33.4009 = $647.64
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.
99471 billing questions
When should 99471 be used instead of 99472?
99471 is for the initial day of inpatient critical care for an eligible infant. Use 99472 for subsequent-day critical care in the same age group.
How does the patient’s age affect code selection?
99471 covers infants from 29 days through 24 months. Neonatal critical care codes 99468 and 99469 cover the neonatal age group, while 99475 and 99476 are for children aged 2 through 5 years.
Is routine inpatient rounding sufficient for 99471?
No. The record should support critical illness or injury requiring intensive physician evaluation and management, not routine care of a stable hospitalized infant.
What documentation supports reporting 99471?
Document the infant’s age, the critical illness or injury, the intensive management furnished, and that the service is for the initial day.
Is 99471 a per-day service?
Yes. It represents the initial day of inpatient pediatric critical care for an infant in the specified age group; subsequent days are represented by 99472.
How is 99471 different from pediatric critical care transport?
99471 represents initial-day inpatient critical care management. Code 99466 describes pediatric critical care during transport, a different service circumstance.
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.
13,13599468,,Neonate crit care initial,A,,18.46,3.71,NA,3.71,,1.14,23.31,23.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13699469,,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
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958