CPT 99469 Fee Schedule

Last Verified: January 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Subsequent Inpatient Neonatal Critical Care, Per Day, For 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	• None • GC - Service performed by resident under supervision • 25 - Significant, separately identifiable E/M service same day
Complexity Level	Moderate

National average reimbursement for CPT 99469 by major payers:

$502.71

$503.06

$475.00

$623.62

Preview provider-level rates for...

For billing codeCPT 99469

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99469
United	99469	$663.75	1659502037 - ANNE LIGGETT	464150987 - (CA) VALLEY CHILDRENS MEDICAL GROUP	CA	Pediatrics Physician (208000000X)
United	99469	$468.29	1942612742 - ROZITA AKHBARI	942196086 - GOLDEN VALLEY HEALTH CENTERS	CA	Pediatrics Physician (208000000X)
United	99469	$565.89	1609800952 - FARZANA PERWAD	943281666	CA	Pediatrics Physician (208000000X)
United	99469	$742.50	1942392683 - NARINDER BALA	770029378	CA	Pediatrics Physician (208000000X)
United	99469	$534.59	1578528709 - ALLAN LAVETTER	770460802	CA	Pediatrics Physician (208000000X)
United	99469	$493.25	1750678231 - CAITLIN RENN	680357690 - ADVENTIST HEALTH PHYSICANS NETWORK	CA	Pediatrics Physician (208000000X)
United	99469	$813.27	1023236148 - AMY DIPIETRO	842411303	CA	Pediatrics Physician (208000000X)
United	99469	$615.61	1508108986 - BARSAM GHARAGOZLOU	822535636 - (CA) BARSAM GHARAGOZLOU MD INC	CA	Pediatrics Physician (208000000X)
United	99469	$475.88	1265486559 - MARGARET DE VILLIERS	831907981 - (CA) ATLAS INTENSIVE CARE	CA	Pediatrics Physician (208000000X)
United	99469	$552.65	1427288588 - GUNJEET KALA AHLUWALIA	843466325 - (CA) KIDSTRONG MEDICAL GROUP INC	CA	Pediatrics Physician (208000000X)
United	99469	$1029.64	1518461300 - RHYS BROOKS	951644600 - CEDARS-SINAI MEDICAL CENTER	CA	Pediatrics Physician (208000000X)
United	99469	$1429.01	1689627580 - BENGT-OLA BENGTSSON	954474603 - PEDIATRIX MEDICAL GROUP OF CALIFORNIA A PROFESSIONAL CORPORATION	CA	Neonatal-Perinatal Medicine Physician (2080N0001X)
United	99469	$652.27	1447323951 - DIANE BEDROSIAN	330483510 - (CA) CENTERS FOR FAMILY MEDICINE, G.P.	CA	Pediatrics Physician (208000000X)
United	99469	$2293.46	1346391240 - HIEUCAM PHAN	943281666	CA	Pediatrics Physician (208000000X)
United	99469	$742.50	1245423342 - TIFFANY OSBURN	464150987 - (CA) VALLEY CHILDRENS MEDICAL GROUP	CA	Pediatrics Physician (208000000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99469 vs. Other Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Codes

The CPT 99469 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 99469 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
99468-CPT	High	Initial Inpatient Neonatal Critical Care, Per Day, For The Evaluation And Management Of A Critically Ill Neonate, 28 Days Of Age Or Younger
99469-CPT	Moderate	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	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
99478-CPT	Low	Subsequent Intensive Care Per Day For The Evaluation And Management Of The Recovering Very Low Birth Weight Infant (Present Body Weight Less Than 1500 Grams)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99469. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99469 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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