CPT code 99469: Neonatal critical care, subsequent day2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $362.48 for 99469 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99469 nationwide

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.

How Washington, DC area compares for 99469

Across 109 of 109 payment localities, the facility rate for 99469 runs from $321.32 in Arkansas to $466.41 in Alaska. Washington, DC area pays $362.48. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99469 rates by state

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

See 99469 in every payment locality

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.

Codes related to 99469

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

How 99469 has changed in Washington, DC area

Price 99469 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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