Ped crit care transport addl
CPT 99467 covers additional 30-minute increments of critical care time during the transport of critically ill or injured children between medical facilities. This is an add-on code used only when pediatric critical care transport exceeds the initial 30-74 minutes covered by the primary transport code.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times for each 30-minute increment; round time appropriately according to CMS guidelines (15-minute minimum beyond the initial period to bill 99467)
Impact: Prevents denials for insufficient time documentation; each properly documented unit yields $110.95 in Medicare reimbursement
99467 is an add-on code and can NEVER be billed alone; always pair with 99466 (the primary pediatric critical care transport code)
Impact: Billing 99467 without 99466 results in automatic denial; correct pairing ensures full payment for extended transports
Bill one unit of 99467 for each additional full 30-minute period beyond the initial 30-74 minutes; for example, a 130-minute transport would be 99466 (x1) + 99467 (x2)
Impact: Accurate unit calculation can add $221.90 for a 2-hour transport extension beyond the initial period
Clearly document the critical nature of the patient's condition and specific interventions performed during transport (ventilator management, medication titration, hemodynamic monitoring)
Impact: Detailed clinical documentation reduces medical necessity denials by 40-60% and supports higher-level audit defense
Verify age eligibility (24 months or younger); patients 25 months and older require different CPT codes (99289-99290 for adults)
Impact: Age documentation errors result in 100% denial; correct age verification ensures proper code selection
Coordinate billing between transport team and receiving/sending facilities to avoid duplicate billing for the same time period; only the transporting physician bills 99466/99467
Impact: Prevents recoupment actions and bundling denials; clear communication can save thousands in overpayment recoveries
Common denials
Missing or incomplete time documentation (lack of specific start/stop times for each 30-minute increment)
How to appeal: Submit supplemental documentation with transport log showing exact timestamps, vehicle departure/arrival times, and physician face-to-face contact periods. Include narrative attestation from transporting physician confirming continuous critical care time.
Code billed without primary code 99466 (stand-alone billing of add-on code)
How to appeal: Verify that 99466 was submitted on the same date of service; if missing, submit corrected claim with both codes. If 99466 was denied, appeal that denial first before addressing 99467. Include transport records showing the complete encounter.
Medical necessity denial due to insufficient documentation of critical illness or critical interventions during transport
How to appeal: Provide detailed clinical notes documenting specific critical care interventions (ventilator settings and adjustments, vasopressor doses, cardiac monitoring, procedures performed). Include vital signs, laboratory values, and narrative description of patient's critical condition necessitating physician-level care during transport.
Patient age exceeds 24 months (age eligibility failure)
How to appeal: If patient was actually ≤24 months, submit birth certificate or medical record documentation confirming age. If age documentation was incorrect and patient was >24 months, rebill with appropriate adult critical care transport codes (99289-99290) rather than appealing the pediatric code denial.
Frequently asked questions
What is CPT code 99467 used for?
CPT 99467 is used to bill for each additional 30-minute increment of critical care time during pediatric interfacility transport for patients 24 months of age or younger. It is an add-on code that must be billed with the primary transport code 99466.
How much does Medicare pay for CPT 99467 in 2025?
The 2025 Medicare national average payment rate for CPT 99467 is $110.95 for both facility and non-facility settings, based on 3.43 total RVUs and the conversion factor of 32.3465.
Can CPT 99467 be billed alone without another code?
No, CPT 99467 is an add-on code and cannot be billed alone. It must always be billed in conjunction with CPT 99466, which represents the initial 30-74 minutes of pediatric critical care transport. Billing 99467 without 99466 will result in automatic denial.
How do you calculate units for CPT 99467 on a long transport?
Bill one unit of 99467 for each full additional 30-minute period beyond the initial 30-74 minutes covered by 99466. For example, a 150-minute transport would be billed as 99466 x1 plus 99467 x2 (covering 75-105 minutes and 105-135 minutes). Time beyond 135 minutes up to 150 minutes would require another unit if it meets the threshold.
What age limit applies to CPT 99467?
CPT 99467 applies only to patients 24 months of age or younger. For patients 25 months and older, use the adult critical care transport codes 99289 and 99290 instead. Age must be clearly documented in the medical record to support code selection.
What documentation is required to bill CPT 99467?
Required documentation includes exact start/stop times for each 30-minute period, patient's critical condition details, specific critical care interventions performed, continuous monitoring data, origin/destination facilities, mode of transport, and physician attestation of direct face-to-face care. Time must be clearly documented to support each billed unit.
What is the difference between 99466 and 99467?
CPT 99466 covers the first 30-74 minutes of pediatric critical care transport and is the primary code. CPT 99467 is the add-on code for each additional 30-minute period beyond the initial time frame. 99467 cannot be billed without 99466, and together they represent the total critical care transport time.