CPT 99475

Initial Ped Critical Care 2 Thru 5 Years

CPT 99475 pays $473.96 in a non-facility setting and $473.96 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $452.30 in Arkansas to $656.55 in Alaska, a 45% spread.

National non-facility rate

$473.96

Office and other outpatient settings

Facility rate
$473.96

Hospital and ASC settings

Highest state
$656.55

Alaska

Lowest state
$452.30

Arkansas · 45% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $473.96
CPT 99475 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $473.96, national facility $473.96.
StateRate compared visuallyNon-facilityFacility
Alaska
$656.55$656.55
District of Columbia
$510.25$510.25
New York
$508.66$508.66
New Jersey
$504.70$504.70
Florida
$495.71$495.71
Illinois
$493.42$493.42
Connecticut
$492.06$492.06
Washington
$491.57$491.57
California
$490.86$490.86
Massachusetts
$490.44$490.44
Maryland
$483.81$483.81
Rhode Island
$481.14$481.14
Michigan
$478.61$478.61
Colorado
$478.32$478.32
Pennsylvania
$477.36$477.36
Georgia
$475.51$475.51
Hawaii
$474.74$474.74
Oregon
$474.72$474.72
Puerto Rico
$474.45$474.45
Virgin Islands
$474.45$474.45
New Hampshire
$474.21$474.21
Montana
$473.91$473.91
West Virginia
$473.86$473.86
Texas
$473.24$473.24
Delaware
$472.64$472.64
New Mexico
$472.26$472.26
Nevada
$470.24$470.24
Louisiana
$468.46$468.46
Arizona
$468.35$468.35
Wyoming
$468.05$468.05
Ohio
$467.57$467.57
Missouri
$467.39$467.39
Utah
$467.11$467.11
Virginia
$466.00$466.00
South Carolina
$464.81$464.81
Kentucky
$463.65$463.65
Maine
$462.12$462.12
Vermont
$461.98$461.98
Oklahoma
$460.82$460.82
North Carolina
$460.70$460.70
North Dakota
$460.47$460.47
Minnesota
$460.16$460.16
South Dakota
$458.88$458.88
Mississippi
$457.54$457.54
Indiana
$456.77$456.77
Tennessee
$456.57$456.57
Idaho
$455.95$455.95
Kansas
$455.45$455.45
Wisconsin
$455.07$455.07
Alabama
$454.67$454.67
Nebraska
$454.02$454.02
Iowa
$453.85$453.85
Arkansas
$452.30$452.30

Billed by 1 specialties

Commercial rates for 99475

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates