Billing code 99472: Pediatric critical careMedicare rate & RVUs in Oregon
Report 99472 for a subsequent day of critical care management for a critically ill infant or young child aged 29 days through 24 months.
CMS doesn’t publish an office rate for 99472 in Oregon.
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 99472 covers
Code 99472 represents a subsequent day of critical care for a critically ill child aged 29 days through 24 months. Pediatric intensivists, hospitalists, and other physicians may provide this care in an ICU or another setting equipped to manage an immediately threatening condition. Examples include acute respiratory failure, septic shock, or severe cardiac instability when the child needs high-complexity decisions to prevent or manage deterioration in a vital organ system.
Select 99472 for a subsequent day, not the initial 24-hour period; use 99471 for that initial period. The record should support the child’s age, critical illness, threatened organ function, and the physician’s high-complexity management on the billed day. This is a daily service, not a code selected by adding up minutes. Routine assessment and management integral to that day’s critical care are part of the service rather than a separate E/M service for the same work.
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 99472 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $358.29 |
| Rest Of Oregon | Unavailable | $345.70 |
How the 99472 rate is calculated
Each of 99472’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 · 99472
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.99Practice expense 1.96Malpractice 0.58
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99472
99472 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 · 99472
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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99472 isn’t priced in this setting.
99472 compared with similar codes
Compare codes
99472 vs 99471 vs 99469 vs 99476: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99471Pediatric critical care
- 99471 covers the initial 24-hour period of pediatric critical care for children aged 29 days through 24 months; 99472 is for subsequent days.
- 99469Neonatal critical care
- 99469 is the subsequent-day neonatal critical care code. Choose based on the patient’s age group, not simply the similarity of the critical-care service.
- 99476Pediatric critical care
- 99476 covers subsequent-day pediatric critical care for children ages 2 through 5 years; 99472 covers ages 29 days through 24 months.
99472 billing questions
When should 99472 be used instead of 99471?
Use 99471 for the initial 24-hour period of pediatric critical care in this age group. Use 99472 for each subsequent day of qualifying critical care.
Does the child have to be in an ICU?
No. The setting alone does not determine code selection; the child must meet the critical-care criteria and receive the required high-complexity management.
Is 99472 based on a number of minutes?
No. It represents a subsequent day of care, rather than a timed increment. Document the critical-care service provided on that day.
Can routine inpatient follow-up be reported as 99472?
No. The child must remain critically ill and require critical-care management; routine daily hospital care alone does not support this code.
What documentation supports 99472?
Document the child’s age, the critical condition and threatened organ function, and the high-complexity assessment and management performed on the subsequent day.
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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