Billing code 99471: Pediatric critical careMedicare rate & RVUs in Ohio
Reports the initial day of inpatient critical care management for a critically ill or injured infant from 29 days through 24 months of age.
CMS doesn’t publish an office rate for 99471 in Ohio.
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 99471 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $665.27 |
How the 99471 rate is calculated
Each of 99471’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 · 99471
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.98Practice expense 3.22Malpractice 0.99
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99471
99471 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 · 99471
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
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99471 isn’t priced in this setting.
99471 compared with similar codes
Compare codes
99471 vs 99472 vs 99468 vs 99475 vs 99466: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99472Pediatric critical care
- Use 99471 for the initial day of critical care in this infant age group; use 99472 for subsequent days.
- 99468Neonatal critical care
- 99468 is the initial-day neonatal critical care code. 99471 is for infants beginning at 29 days of age.
- 99475Pediatric critical care
- 99475 covers initial-day critical care for children aged 2 through 5 years; 99471 is for the younger infant group.
- 99466Critical care transport
- 99466 describes pediatric critical care during transport. 99471 is for initial-day inpatient critical care management.
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 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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