2025 CPT code 99471
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Initial Inpatient Pediatric Critical Care Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Feed
Initial inpatient pediatric critical care, per day, for a critically ill infant or young child aged 29 days to 24 months.
Modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) may be appended if additional significant E/M services are provided on the same day and meet the criteria for separate reporting.
Medical necessity for 99471 is established by documentation supporting the patient's critical condition requiring constant monitoring, frequent interventions, and complex medical management.The patient must meet established criteria for critical illness, and the documentation must demonstrate the complexity and intensity of the care provided.
The physician or other qualified healthcare professional is responsible for the comprehensive evaluation, management, and ongoing care of the critically ill infant or young child. This includes assessment, diagnosis, treatment planning, and ongoing monitoring of the patient's condition.
- Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
- Inpatient Pediatric Critical Care
In simple words: This code is for the first day of critical care in the hospital for a baby or young child (29 days to 2 years old) who is very sick. The doctor assesses the child, makes a treatment plan, and manages the care during that first day. This code doesn't include other hospital services performed that day; those will be billed separately.
This code reports the initial daily evaluation and management of a critically ill infant or young child aged 29 days to 24 months in an inpatient setting.It encompasses the physician's comprehensive assessment, development of a treatment plan, and ongoing management of the critically ill patient.The service includes procedures typically associated with critical care, as defined in the CPT guidelines.This code is only for the initial evaluation and management service on the first day of admission. Subsequent days of critical care are coded separately.
Example 1: A 6-month-old infant is admitted to the hospital with respiratory distress syndrome requiring mechanical ventilation and close monitoring. Code 99471 would be reported for the initial day of critical care., A 1-year-old child is admitted following a motor vehicle accident with severe head trauma requiring neurosurgical intervention. Code 99471 would be reported for the initial day of critical care, along with codes for any other procedures performed., A 2-year-old child is admitted with septic shock requiring intravenous antibiotics, fluid resuscitation, and vasopressor support.Code 99471 is reported for the initial day of critical care.
Detailed medical record documentation is necessary to support the medical necessity of critical care services. This should include the history of present illness, detailed physical examination findings, the severity of the patient's condition, the intensity of the services provided, and the physician's plan of care.Supporting documentation should demonstrate the patient's critical illness and the need for ongoing critical care management.
** Code 99471 should only be reported once per day, per patient, by a single physician or other qualified healthcare professional.It should only be used for the initial critical care service on the day of admission. Subsequent days of critical care require the use of code 99472.
- Revenue Code: M2C (Hospital Visit - Critical Care)
- RVU: This information is not readily available in the provided text and would require referencing the current CPT codebook or other official reimbursement sources.
- Global Days: This code is reported daily. The global period is one day.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code.
- Fee Schedule: This information is not provided and would require referring to historical fee schedules and payment policies from various payers.
- Specialties:Neonatology, Pediatrics, Critical Care Medicine
- Place of Service:Inpatient Hospital