No office rate
99468 identifies the initial day of neonatal critical care; 99469 is for subsequent days.
On this page
CMS RVU26D · Effective 2026-10-01
99468 Neonatal critical care Medicare reimbursement rates in Massachusetts
Report 99468 for the initial inpatient critical-care day managing a critically ill neonate who is 30 days of age or younger. Compare 99468 office and facility rates across CMS payment localities in Massachusetts.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99468 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$787.28–$823.71
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Critical care
About 99468: Initial neonatal critical care
Report 99468 for the initial inpatient critical-care day managing a critically ill neonate who is 30 days of age or younger.
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.
Where the value comes from
- Work RVU18.46 · 79%
- Practice expense (office) RVU3.71 · 16%
- Malpractice RVU1.14 · 5%
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.
99468 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Use 99468 when the neonate’s condition requires critical-care management. Use 99477 for intensive newborn care that does not meet critical-care circumstances.
No office rate
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.
Compare 99468 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$823.71
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$787.28
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,13299465,,Nb resuscitation,A,,2.93,0.59,NA,0.59,,0.18,3.70,3.70,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13399466,,Ped crit care transport,A,,4.79,0.97,NA,0.97,,0.28,6.04,6.04,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13499467,,Ped crit care transport addl,A,,2.40,0.48,NA,0.48,,0.15,3.03,3.03,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13599468,,Neonate crit care initial,A,,18.46,3.71,NA,3.71,,1.14,23.31,23.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13699469,,Neonate crit care subsq,A,,7.99,1.61,NA,1.61,,0.48,10.08,10.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13799470,,Rpm tx mgmt 1st 10 min,A,,0.31,0.45,,0.07,,0.02,0.78,0.40,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13899471,,Ped critical care initial,A,,15.98,3.22,NA,3.22,,0.99,20.19,20.19,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00