CPT 99467E&M

Ped crit care transport addl

CPT 99467 covers additional 30-minute increments of critical care transport services for critically ill or injured pediatric patients aged 24 months or younger. This is an add-on code used after the initial pediatric critical care transport service.

Showing rates for

National Average

Base Medicare rate

$110.95

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

2.4

PE RVU (NF)

0.87

MP RVU

0.16

Total RVU

3.43

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 for each 30-minute increment with precise timestamps in the medical record. Time begins when physician assumes direct care and ends when care is transferred at the receiving facility.
Impact: Each properly documented 30-minute unit yields $110.95; incomplete time documentation is the leading cause of downcoding or denial, potentially costing $110.95 per lost unit
Bill only full 30-minute increments—partial periods under 30 minutes beyond the initial transport code cannot be separately reported. If transport extends 15 minutes beyond a full increment, that time is not billable.
Impact: Prevents automatic denials for fractional units and audit triggers; attempting to bill partial units results in 100% denial of those claims
Ensure the primary pediatric critical care transport code (99466 or 99485) is billed first; 99467 is an add-on code and will deny if billed without the appropriate primary code on the same claim.
Impact: Prevents automatic system denials; claims submitted without the primary code result in 100% denial of all 99467 units ($110.95 per denied unit)
Document all critical care interventions performed during each 30-minute segment including ventilator adjustments, medication administration, hemodynamic monitoring, and resuscitative efforts to support medical necessity.
Impact: Strengthens medical necessity defense during audits; inadequate documentation can result in full recoupment of payments averaging $110.95 per unit across entire audit sample
Verify patient age is 24 months or younger on the date of service; age 25 months or older requires different transport codes and will result in denial or recoupment.
Impact: Age discrepancies trigger 100% denials; using incorrect age-based codes can result in lost revenue of $110.95 per unit plus potential audit expansion

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 99467 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 99467 is $110.95 for both facility and non-facility settings. This rate is based on a total RVU of 3.43 (Work RVU 2.4, PE RVU 0.87, MP RVU 0.16) multiplied by the 2025 conversion factor of 32.3465.

How many units of 99467 can I bill for a 2-hour pediatric critical care transport?

For a 2-hour (120 minute) transport, you would bill the primary transport code (99466) for the first 30-74 minutes, then bill 99467 for each additional full 30-minute increment. A 120-minute transport typically yields the primary code plus two units of 99467, assuming the first code covers the initial period and two additional 30-minute segments remain.

Can 99467 be billed alone without another code?

No, CPT 99467 is an add-on code and cannot be billed independently. It must be reported with a primary pediatric critical care transport code such as 99466 (initial 30-74 minutes, younger than 24 months) or 99485 (supervision by attending physician). Billing 99467 without the primary code will result in automatic denial.

What age range qualifies for CPT code 99467?

CPT 99467 is used exclusively for critically ill or injured pediatric patients aged 24 months or younger on the date of service. Patients 25 months and older require different critical care transport codes (99289-99290). Age must be clearly documented in the medical record.

Does 99467 require face-to-face physician time or can it include indirect supervision?

CPT 99467 requires direct face-to-face physician presence and attendance during the transport. The physician must physically accompany the patient in the transport vehicle (ambulance, helicopter, or aircraft) and provide hands-on critical care throughout each 30-minute increment. Indirect supervision or telephone consultation does not qualify.

How do I document time for CPT 99467 to avoid denials?

Document precise start time (when physician assumes direct patient care for transport) and stop time (when care is transferred to receiving facility team) in the medical record. Include the total elapsed time, note any interruptions, calculate full 30-minute increments, and have the physician attest to continuous bedside presence. Trip sheets and transport logs should correlate with medical record times.

What is the difference between 99467 and 99466?

CPT 99466 is the primary code for the initial 30-74 minutes of pediatric critical care transport (24 months or younger), while 99467 is the add-on code for each additional 30 minutes beyond the first 30-74 minutes. 99466 stands alone; 99467 can only be billed with 99466 or 99485 and represents extended transport duration requiring ongoing physician critical care.