CPT code 99469: Neonatal critical care, subsequent day2026 Medicare rate & RVUs in Maine
Report subsequent inpatient neonatal critical care for daily evaluation and management of a critically ill neonate who is 30 days old or younger.
CMS doesn’t publish an office rate for 99469 in Maine.
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 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 in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | Unavailable | $326.32 |
| Southern Maine, ME | Unavailable | $330.28 |
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.
How the rate is built · 99469
RVUs × geographic indexes × conversion factor
Work7.99
7.99 RVUs× 1.000 GPCI
Practice expense1.61
1.61 RVUs× 1.000 GPCI
Malpractice0.48
0.48 RVUs× 1.000 GPCI
Adjusted RVUs
10.0800
Conversion factor
$33.4009
Medicare rate
$336.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99469
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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99469 isn’t priced in this setting.
99469 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99469 billing questions
Can 99469 be reported for routine newborn care?
No. The infant must be critically ill and receive inpatient critical care; routine newborn evaluation or intensive observation without critical illness calls for a different service code.
How many units are reported for a day of care?
99469 is reported per day, not by each bedside visit or intervention. The documentation should support the physician’s critical-care evaluation and management on that subsequent day.
What documentation supports 99469?
Document the neonate’s age, critical condition, and the day’s assessment and management, including significant changes, clinical decisions, and interventions relevant to ongoing critical care.
How does 99469 differ from 99477?
99469 is for subsequent-day management of a critically ill neonate. 99477 describes initial hospital care for a neonate needing intensive observation and frequent interventions, rather than the subsequent critical-care service represented by 99469.
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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