CPT 99471 Evaluation & Management
Ped critical care initial Cost
Body System: General
Medicare Facility Rate
$674
CMS PFS CY2026
Medicare Non-Facility Rate
$674
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
15.98
Work RVU
3.22
Facility PE RVU
0.99
Malpractice RVU
20.19
Total RVU
Frequently Asked Questions
How much does Ped critical care initial cost?
The Medicare facility rate is $674. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Ped critical care initial cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $674.