CPT 99466E&M

Ped crit care transport

CPT 99466 covers the physician's direct face-to-face care during the critical care transport of a seriously ill or injured child from one facility to another. This includes ground or air ambulance transport where the physician is physically present and providing continuous critical care throughout the journey.

Showing rates for

National Average

Base Medicare rate

$221.25

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

4.79

PE RVU (NF)

1.72

MP RVU

0.33

Total RVU

6.84

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact start and stop times of face-to-face critical care during transport, measured from when physician assumes direct care until patient care is transferred at receiving facility
Impact: Time documentation errors are the leading cause of denials; precise documentation supports the $221.25 base reimbursement and justifies add-on code 99467 for time beyond 74 minutes
Bill 99466 only once per transport encounter regardless of distance; use 99467 for each additional 30 minutes beyond the first 74 minutes
Impact: Each unit of 99467 adds approximately $179.20 to reimbursement; a 2-hour transport would generate $221.25 + $179.20 = $400.45 total
Ensure medical necessity documentation demonstrates critical illness requiring continuous physician presence; stable patients not requiring critical interventions do not qualify
Impact: Medical necessity denials can result in 100% payment loss ($221.25 per encounter); document specific interventions, medications, ventilator management, or hemodynamic instability
Verify patient age is 24 months or younger at time of transport; patients 25 months or older require different codes (99289-99290)
Impact: Age coding errors trigger automatic denials; using wrong code family may result in underpayment or complete claim rejection
Do not bill 99466 in combination with other E/M services on same date by same physician; transport critical care is comprehensive and includes pre-transport stabilization
Impact: Bundling violations can trigger audit flags and recoupment of $221.25 plus potential penalties; keep transport documentation separate from referring facility E/M notes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 99466 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 99466 is $221.25 for both facility and non-facility settings. This rate is based on a total RVU of 6.84 (Work RVU: 4.79, PE RVU: 1.72, MP RVU: 0.33) multiplied by the 2025 conversion factor of 32.3465.

How much time must be spent to bill CPT code 99466?

CPT 99466 requires a minimum of 30 minutes and covers up to 74 minutes of direct face-to-face critical care time during pediatric transport. For transports lasting 75 minutes or longer, you would bill 99466 for the first 30-74 minutes, then add CPT 99467 for each additional 30-minute increment beyond 74 minutes.

Can CPT 99466 be billed with other E/M codes on the same day?

Generally, no. CPT 99466 is typically not billed with other E/M services provided by the same physician on the same date, as the transport critical care service is comprehensive and includes pre-transport stabilization. However, if a different physician from a different specialty provides a completely separate E/M service unrelated to the transport, it may be billable with appropriate documentation and modifiers.

What is the age limit for using CPT code 99466?

CPT 99466 is specifically for pediatric patients 24 months of age or younger at the time of transport. For critically ill or injured patients 25 months and older, you must use the adult/pediatric critical care transport codes 99289-99290 instead.

Does CPT 99466 require the physician to physically accompany the patient in the ambulance?

Yes, absolutely. CPT 99466 requires direct face-to-face physician attendance during the entire interfacility transport. The physician must be physically present with the patient in the ambulance, helicopter, or other transport vehicle, continuously providing or supervising critical care services. Remote physician supervision or nurse/paramedic-only transport does not qualify for this code.

What is the difference between CPT 99466 and 99467?

CPT 99466 is the primary code covering the first 30-74 minutes of physician-attended pediatric critical care transport. CPT 99467 is an add-on code used to report each additional 30 minutes of transport time beyond the initial 74 minutes. For example, a 120-minute transport would be coded as 99466 plus one unit of 99467.

What documentation is needed to support medical necessity for CPT 99466?

Documentation must clearly establish that the patient's condition is critically ill or injured, requiring continuous physician-level interventions that cannot be safely interrupted during transport. This includes detailed notes on specific critical care services provided (mechanical ventilation management, vasoactive medication titration, invasive monitoring, resuscitation), vital signs showing instability, and clinical justification for why physician attendance was medically necessary rather than standard paramedic or nurse-attended transport.