CPT code 99468: Neonatal critical care, initial day2026 Medicare rate & RVUs in Texas
Report 99468 for the initial inpatient critical-care day managing a critically ill neonate who is 30 days of age or younger.
CMS doesn’t publish an office rate for 99468 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99468 covers
99468 represents the initial day of inpatient critical-care management for a critically ill neonate aged 30 days or younger. Typical patients are in a NICU with acute respiratory failure, sepsis with cardiovascular instability, or another condition involving acute vital-organ impairment and a high risk of life-threatening deterioration. Neonatologists and pediatric intensivists commonly provide this service. Routine newborn nursery care or attendance at delivery alone is not neonatal critical care.
Report 99468 for the initial day of neonatal critical care and use 99469 for qualifying critical care on later days. Documentation should establish the neonate’s age, critical illness and risk of deterioration, the assessment and active management provided, and the date critical care began. The code is reported per day, not by the hour. A NICU location or intensive observation alone does not establish that the patient’s condition required critical care; when care is intensive but does not meet critical-care circumstances, consider 99477.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99468 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $782.65 |
| Beaumont, TX | Unavailable | $764.72 |
| Brazoria, TX | Unavailable | $774.02 |
| Dallas, TX | Unavailable | $778.22 |
| Fort Worth, TX | Unavailable | $777.48 |
| Galveston, TX | Unavailable | $776.09 |
| Houston, TX | Unavailable | $796.96 |
| Rest of Texas | Unavailable | $768.56 |
How the 99468 rate is calculated
Each of 99468’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99468
RVUs × geographic indexes × conversion factor
Work18.46
18.46 RVUs× 1.000 GPCI
Practice expense3.71
3.71 RVUs× 1.000 GPCI
Malpractice1.14
1.14 RVUs× 1.000 GPCI
Adjusted RVUs
23.3100
Conversion factor
$33.4009
Medicare rate
$778.57
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99468
99468 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99468
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99468 isn’t priced in this setting.
99468 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99469Neonatal critical careSubsequent day
- 99468 identifies the initial day of neonatal critical care; 99469 is for subsequent days.
- 99477Neonatal careInitial intensive-care day
- Use 99468 when the neonate’s condition requires critical-care management. Use 99477 for intensive newborn care that does not meet critical-care circumstances.
- 99471Pediatric critical careInitial day, age 29 days–24 months
- 99468 is the neonatal critical-care code for a neonate 30 days of age or younger. 99471 is for pediatric critical care within its separate age criteria.
99468 billing questions
When should 99468 be used instead of 99469?
Use 99468 for the initial day of neonatal critical-care management. Use 99469 for qualifying neonatal critical care on subsequent days.
Does a NICU admission by itself support 99468?
No. The documentation should support a critically ill neonate with acute vital-organ impairment and a high risk of life-threatening deterioration, along with active critical-care management.
Is 99468 reported by hours or by days?
It is a per-day service. Do not convert the time spent managing the neonate into hourly units.
What should the note document for 99468?
Document the neonate’s age, critical condition and risk of deterioration, the evaluation and active management, and that this was the initial day of neonatal critical care.
How does 99468 differ from 99477?
99468 is for a critically ill neonate requiring critical-care management. Consider 99477 for intensive newborn care when the clinical circumstances do not meet critical-care criteria.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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