2025 CPT code 99466
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Pediatric Critical Care Patient Transport Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Feed
Provides initial face-to-face critical care during interfacility transport of a critically ill or injured pediatric patient (≤24 months) for 30-74 minutes.
Modifiers may apply based on the circumstances of the service. Consult the CPT manual for appropriate modifier usage.
The medical necessity is determined by the patient’s critical illness or injury, necessitating transport to a facility better equipped to manage their condition. Documentation should clearly support the medical necessity for the transport and the level of critical care provided.
The physician assumes primary responsibility for the patient's care during transport, providing direct hands-on medical care and making critical clinical decisions.
- Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
- Evaluation and Management; Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services; Pediatric Critical Care Patient Transport
In simple words: This code covers a doctor's hands-on care of a very sick or injured child under 2 years old while the child is being moved between hospitals. The doctor's care must last at least 30 minutes but less than 75 minutes.
CPT code 99466 reports the first 30 to 74 minutes of direct, face-to-face critical care provided by a physician during the interfacility transport of a critically ill or injured pediatric patient who is 24 months of age or younger.This code encompasses the period from when the physician assumes primary responsibility at the referring facility until the receiving facility accepts responsibility. Only direct face-to-face time with the patient should be included.Services performed by other members of the transport team are not reported under this code.If the transport exceeds 74 minutes, additional time in 30-minute increments is reported using code 99467.
Example 1: A neonate with respiratory distress is transferred from a rural hospital to a tertiary care center. The attending neonatologist accompanies the infant during transport, providing continuous monitoring, ventilation support, and medication adjustments.The total transport time is 45 minutes., A 1-year-old child in a motor vehicle accident is transported to a trauma center. A pediatric surgeon accompanies the patient and manages airway, hemorrhage control, and other life-saving measures during the 60-minute transport., A 2-year-old child experiencing a severe allergic reaction requires immediate transport to a specialized allergy center. A pediatric allergist accompanies the patient, managing airway, administering medications, and closely monitoring the child's condition. The transport takes 35 minutes.
Detailed documentation should include the patient's age, diagnosis, clinical status, start and end times of the transport and physician’s face-to-face care, procedures performed, medications administered, and a narrative detailing the critical care provided.Appropriate documentation supporting the medical necessity of the transport should also be included.
** This code should only be used when the physician is providing direct, hands-on critical care during transport.The time spent should be accurately documented.Ensure compliance with all relevant regulations and payer-specific guidelines.
- Revenue Code: M2C (Hospital Visit - Critical Care)
- RVU: This information is not readily available in the provided text. Consult the official CPT codebook or a medical billing resource for RVU data.
- Global Days: This code does not have a defined global period.Billing is based on the time spent providing direct face-to-face care during transport.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a single procedure code encompassing the complete service.
- Fee Schedule: Historical fee schedule data is not available in the provided text. Consult a fee schedule database or other billing resource for historical payment information.
- Specialties:Neonatology, Pediatric Critical Care Medicine, Emergency Medicine, Pediatric Surgery
- Place of Service:Ambulance - Land, Ambulance - Air or Water