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See a sample rate comparisonCPT 99468 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Initial Inpatient Neonatal Cri, Initial Inpatient Neonatal Critical Care Per Dayfor The Evaluation And Management Of A Critically Ill Neonate 28 Days Of Age Or Younger
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $778.58 national non-facility rate (2026) · View Medicare rates for 99468 |
| Medicaid Fee Schedule | $644.97 median of the 8 states in the free preview · View Medicaid rates for 99468 |
National average reimbursement for CPT 99468 by major payers:
$1,154.95
$1,164.09
$1,072.20
$1,429.21
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CPT 99468
5 of 25 sample ratesHigher to lower in this preview
Michael Waterfield
$5,295.60Published rateVikash Agrawal
Faculty Physicians And Surgeons Of Llusm
$2,195.62Published rateLillian Lai-Wu
Providence Medical Foundation
$1,278.09Published rateEileen Chan
$920.32Published rateJoanne Asuncion
$813.85Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99468 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes
The CPT 99468 code is part of the Evaluation and Management services used for Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99468 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99466-CPT | Moderate | Critical Care In Ambulance, Physician Services Delivered To A Critically Ill Or Injured Toddler During A Transfer From One Facility To Another. Physician Time Varies According To Travel Time As Well As The Childs Condition And Treatment Needs. |
| 99468-CPT | High | Initial Inpatient Neonatal Cri, Initial Inpatient Neonatal Critical Care Per Dayfor The Evaluation And Management Of A Critically Ill Neonate 28 Days Of Age Or Younger |
| 99469-CPT | Moderate | Subsequent Inpatient Neonatal, Subsequent Inpatient Neonatal Critical Care Per Day For The Evaluation And Management Of A Critically Ill Neonate 28 Days Of Age Or Younger |
| 99477-CPT | Moderate | Init Day Hosp Neonate Care, Initial Hospital Care Per Day For The Evaluation And Management Of The Neonate 28 Days Of Age Or Younger Who Requires Intensive Observation Frequent Interventions And Other Intensive Care Services |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99468. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99468 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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