CPT 99471
Global XXX ActivePed critical care initial
CPT 99471 Billing & Documentation Guide
CPT code 99471 (Ped critical care initial) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 15.98, a non-facility practice expense RVU of 3.22, and a malpractice RVU of 0.99, a total non-facility RVU of 20.19 and facility RVU of 20.19. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $685.21, though rates vary from $643.16 to $933.38 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99471, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99471 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99471 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99471
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 15.98 | 15.98 |
| Practice Expense RVU | 3.22 | 3.22 |
| Malpractice RVU | 0.99 | 0.99 |
| Total RVU | 20.19 | 20.19 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99471
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $698.07 | $698.07 | $678.42 - $765.27 | 29 |
| Florida | $706.02 | $706.02 | $686.26 - $729.33 | 3 |
| Georgia | $676.72 | $676.72 | $669.1 - $684.33 | 2 |
| Illinois | $702.72 | $702.72 | $683.62 - $721.46 | 4 |
| Michigan | $681.28 | $681.28 | $669.27 - $693.28 | 2 |
| North Carolina | $655.22 | $655.22 | $655.22 - $655.22 | 1 |
| New York | $723.99 | $723.99 | $659.17 - $757.19 | 5 |
| Ohio | $665.27 | $665.27 | $665.27 - $665.27 | 1 |
| Pennsylvania | $679.25 | $679.25 | $663.73 - $694.76 | 2 |
| Texas | $673.28 | $673.28 | $662.34 - $690.31 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99471
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99471 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0188T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0189T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99471
What does CPT code 99471 mean? +
CPT code 99471 represents: Ped critical care initial. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99471? +
The 2026 Medicare national average non-facility payment for CPT 99471 is $685.21. Rates range from $643.16 to $933.38 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99471? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99471? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team