CPT code 99469: Neonatal critical care, subsequent day2026 Medicare rate & RVUs

Medicare pays $336.68 for 99469 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99469 covers

This service covers a subsequent day of inpatient evaluation and management for a critically ill neonate who is 30 days of age or younger. A neonatologist or other physician providing critical care typically reports it in a neonatal intensive care setting when the infant’s condition requires high-complexity assessment and active management, rather than routine newborn care or observation alone.

Report 99469 for a subsequent day after the initial neonatal critical care day, which is reported with 99468. The record should establish the infant’s age, critical illness, and the physician’s ongoing evaluation and management that day, including relevant clinical changes, decisions, and interventions. It is a per-day service; select a different care code when the infant does not meet the critical-care circumstances or falls into a different age or clinical category.

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 99469 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99469 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99469 rate is calculated

Each of 99469’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.

Payment rules and modifiers for 99469

99469 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.

99469 compared with similar codes

How to choose

99468Neonatal critical careInitial day

99468 is reported for the initial day of inpatient neonatal critical care; 99469 is for a subsequent day.

99472Pediatric critical careSubsequent day, ages 29 days–24 months

99472 covers subsequent inpatient pediatric critical care for a different age group. Use 99469 for a critically ill neonate 30 days old or younger.

99477Neonatal careInitial intensive-care day

99477 is initial hospital care for a neonate requiring intensive observation and frequent interventions. 99469 is subsequent-day care for a critically ill neonate.

99478Infant intensive careCurrent weight under 1,500 grams

99478 covers subsequent intensive care for a low-birth-weight infant within its specified birth-weight range, rather than subsequent critical care selected for neonatal critical illness.

Codes related to 99469

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates