2025 CPT code 99472
(Active) Effective Date: N/A Revision Date: N/A Critical Care - Subsequent inpatient pediatric critical care Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Feed
Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child aged 29 days to 24 months.
Modifiers may be applicable in certain situations, such as modifier 25 for a significant, separately identifiable evaluation and management service performed on the same day. Consult the CPT guidelines for appropriate modifier usage.
Medical necessity is established when the patient meets the criteria for critical care, which includes the severity of the illness or injury, the need for close monitoring and intervention, and the complexity of medical decision-making.
The physician or qualified healthcare professional provides ongoing critical care to the critically ill infant or young child, including close monitoring of vital signs, assessment of the patient's condition, and management of the treatment plan.
- Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
- Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
In simple words: This code is for the daily follow-up care of a very sick baby or young child (29 days to 2 years old) who is in the hospital.It's used after the first day of intensive care in the same hospital stay.
This code reports subsequent inpatient pediatric critical care services provided per day for the evaluation and management of a critically ill infant or young child aged 29 days to 24 months.It covers the ongoing care of a critically ill patient after the initial critical care visit (99471) during the same hospital admission.The services included are those typically provided in a critical care setting. This code is used only after the initial critical care code (99471) has been billed for the same admission.
Example 1: A 6-month-old infant admitted for respiratory distress requiring mechanical ventilation.After the initial critical care (99471) on day 1, 99472 is used for subsequent days of critical care., A 1-year-old child admitted for septic shock. The initial critical care (99471) is billed on day 1, and 99472 is billed for days 2-5 of the hospitalization while the child remains critically ill., A 23-month-old child admitted for a complex cardiac condition. The initial critical care (99471) was billed on admission. 99472 is used each day that the child remains in the ICU and is critically ill.
Detailed daily progress notes documenting the patient's condition, interventions provided, and response to treatment.This should include vital signs, lab results, medication administration, and any procedures performed.The medical record should support the medical necessity of critical care.
** This code should only be billed once per day by a single provider for the same patient.It can't be reported for patients younger than 29 days.This code is for inpatient care only. For outpatient critical care, use codes 99291 and 99292.
- Global Days: This code is billed per day.The global period is not applicable.
- Payment Status: Active
- Modifier TC rule: The TC modifier (technical component) does not typically apply to this code, as it represents the physician's critical care services.
- Specialties:Neonatology, Pediatrics, Critical Care Medicine
- Place of Service:Inpatient Hospital