No office rate
99468 is reported for the initial day of inpatient neonatal critical care; 99469 is for a subsequent day.
On this page
CMS RVU26D · Effective 2026-10-01
99469 Neonatal critical care Medicare reimbursement rates in New Jersey
Report subsequent inpatient neonatal critical care for daily evaluation and management of a critically ill neonate who is 30 days old or younger. Compare 99469 office and facility rates across CMS payment localities in New Jersey.
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 99469 in New Jersey?
New Jersey 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
$353.86–$363.19
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 99469: Subsequent neonatal critical care
Report subsequent inpatient neonatal critical care for daily evaluation and management of a critically ill neonate who is 30 days old or younger.
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.
Where the value comes from
- Work RVU7.99 · 79%
- Practice expense (office) RVU1.61 · 16%
- Malpractice RVU0.48 · 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.
99469 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
99472 covers subsequent inpatient pediatric critical care for a different age group. Use 99469 for a critically ill neonate 30 days old or younger.
No office rate
99477 is initial hospital care for a neonate requiring intensive observation and frequent interventions. 99469 is subsequent-day care for a critically ill neonate.
No office rate
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.
Compare 99469 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$363.19
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$353.86
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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 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.
13,13399466,,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
13,13999472,,Ped critical care subsq,A,,7.99,1.96,NA,1.96,,0.58,10.53,10.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00