2025 CPT code 99476
(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 a critically ill child aged 2-5 years.
Modifiers may apply depending on the circumstances of service.For example, modifier 25 could be used if a significant, separately identifiable E/M service was performed on the same day.
The medical necessity for this code rests on the patient's critical condition requiring constant monitoring, frequent interventions, and intensive care services.This necessitates the resources and expertise of a specialized critical care unit.Documentation must clearly demonstrate the medical necessity to support the claim.
The physician or qualified healthcare professional directs the ongoing inpatient care of a critically ill child, performing evaluations, implementing the management plan, and providing necessary interventions. This involves close monitoring, frequent assessments, and managing complications.
- Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
- Inpatient Neonatal and Pediatric Critical Care
In simple words: This code covers the doctor's daily follow-up care for a very sick child (ages 2 to 5) who is in the hospital. The doctor watches the child closely, gives needed treatments, and makes sure the child is getting better.
This CPT code reports subsequent inpatient pediatric critical care services provided to a critically ill infant or young child aged 2 through 5 years.It encompasses a full calendar day of intensive observation, frequent interventions, and other intensive care services.This code is used for each day after the initial critical care day (99475) within the same hospital admission.The services included are similar to those covered under codes 99291 and 99292, but specific to this age group and inpatient setting.
Example 1: A 3-year-old child is admitted to the hospital with respiratory distress requiring mechanical ventilation. Code 99476 is used for each subsequent day the child remains critically ill and requires intensive care., A 4-year-old child is hospitalized after a serious motor vehicle accident. After the initial critical care code (99475), code 99476 is billed for each day the child requires intensive care management for injuries including multiple fractures, head trauma, and internal bleeding., A 2-year-old with severe sepsis is admitted to the pediatric intensive care unit.After the initial critical care visit (99475), the physician bills 99476 for each day of continued intensive care, including monitoring vital signs, administering medications, and managing fluid balance.
Detailed daily progress notes documenting the patient's condition, vital signs, interventions provided (e.g., medications, respiratory support), and physician's evaluations.Supporting laboratory results and other diagnostic tests should also be included.The medical necessity for continued critical care should be clearly documented.
** This code is only reportable once per calendar day, per patient, by a single individual.It should not be reported for a patient who is no longer considered critically ill.For patients requiring intensive care but not meeting the criteria for critical care, use codes 99477-99480.
- Revenue Code: M2C (HOSPITAL VISIT - CRITICAL CARE)
- RVU: The relative value units (RVUs) for this code vary depending on the geographic location and other factors. Consult the CMS Physician Fee Schedule for the most current RVU values and payment rates.
- Global Days: This code is reported for each day of subsequent critical care.There is no specific global period associated with this daily code.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not apply to this code as it represents the physician's professional services in directing the critical care.
- Fee Schedule: Historical fee schedule information is not included in this response. Consult the CMS Physician Fee Schedule database for historical payment rates.
- Specialties:Pediatric Critical Care Medicine, Neonatology
- Place of Service:Inpatient Hospital