Billing code 99468: Neonatal critical careMedicare rate & RVUs

Medicare pays $778.57 for 99468 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 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

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

109 of 109 payment localities

99468 rates by state

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

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.

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.

99468 compared with similar codes

How to choose

99469Neonatal critical care

99468 identifies the initial day of neonatal critical care; 99469 is for subsequent days.

99477Neonatal care

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 care

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.

Codes related to 99468

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