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    v1.0.30
    OpenPayerBilling CodesInpatient Neonatal and Pediatric Critical CareCPT cpt-99476-pediatric-critical-care-follow-up-inpatient
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    CPT 99476: Follow-up Care for Critically Ill Child, Age 2–5 Years

    Medicare pays $313 on average nationally for this procedure.

    CPT code 99476 describes follow-up care provided by a clinician for a critically ill child aged two to five years in an inpatient setting, representing a pediatric critical care follow-up service where the provider evaluates clinical status and coordinates ongoing inpatient management; service type: follow-up critical care evaluation; typical site of service: inpatient (hospital) setting.

    For related coverage guidance, see recent payer policy updates: Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy, Emergency Air/Water Ambulance Services Medical Guideline, Non-Emergent Ambulance Services.

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    Clinical & Coding Specifications

    Clinical Context

    A 3-year-old child is admitted to the pediatric intensive care unit with respiratory failure due to severe bronchiolitis requiring intubation and mechanical ventilation. The child is critically ill, unstable, and requires continuous intensive monitoring, ventilator management, vasoactive support, and frequent reassessments by the attending pediatric intensivist. The attending physician performs a focused follow-up visit the next day to evaluate current organ support, ventilator settings, sedation requirements, fluid balance, and to discuss ongoing goals of care with the bedside team and the child’s parents. Documentation includes the patient’s current vital signs, ventilator parameters, assessment of end-organ perfusion, changes in medications or interventions, time spent reviewing the patient’s course and coordinating care, and a statement that the child remains critically ill.

    Typical site of service: Inpatient pediatric intensive care unit (PICU).

    Service type: Follow-up critical care visit for a pediatric patient ages two to five years in an inpatient setting.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99477Initial inpatient critical care, per day, for the evaluation and management of a critically ill infant under 2 years of ageUsed when the patient is under 2 years old for initial critical care rather than the follow-up pediatric code for ages 2–5
    99478Subsequent inpatient critical care, per day, for critically ill infant less than 2 years of ageUsed for subsequent critical care days for infants; parallels the age-based differentiation in pediatric critical care coding
    99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutesMay be used for adult critical care or when payer requires standard adult critical care codes; not age-specific for pediatrics
    99292Critical care, each additional 30 minutesTime-based add-on when critical care extends beyond the initial time unit; used alongside 99291 when applicable
    99356Prolonged physician service in the inpatient setting, first hour (without direct patient contact)Used when prolonged care or coordination extends beyond typical critical care time and prolonged service reporting is appropriate
    99499Unlisted evaluation and management serviceUsed only when no other code accurately describes a nonstandard critical care service or for unique care circumstances

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    2080P0206X
    207R00000X
    207L00000X
    229N00000X
    173F00000X
    207RS0012X
    2279P1005X

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01

    Related Codes

    CPT-99468-INITIAL-NEONATAL-CRITICAL-CARE-EVALUATION

    CPT 99468: Initial Neonatal Critical Care Evaluation

    CPT-99469-SUBSEQUENT-NEONATAL-CRITICAL-CARE-EM-VM

    CPT 99469: Subsequent Neonatal Critical Care, <28 Days

    CPT-99471-CRITICAL-CARE-INFANT-INPATIENT-INITIAL-EVALUATION

    CPT 99471: Initial Critical Care for Infant 29 Days–24 Months

    CPT-99472-INPATIENT-FOLLOW-UP-CRITICALLY-ILL-INFANT-YOUNG-CHILD

    CPT 99472: Follow-Up Critical Care for Critically Ill Infant or Young Child

    CPT-99475-INITIAL-CRITICAL-CARE-CHILD-2-TO-5-INPATIENT

    CPT 99475: Initial Evaluation and Management of Critically Ill Child (2–5 yrs)

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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