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See a sample rate comparisonCPT 99469 Fee Schedule
Last Verified: October 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, 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 | GC - Service performed by resident under supervision 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $336.68 national non-facility rate (2026) · View Medicare rates for 99469 |
| Medicaid Fee Schedule | $316.345 median of the 8 states in the free preview · View Medicaid rates for 99469 |
National average reimbursement for CPT 99469 by major payers:
$502.71
$503.06
$475.00
$623.85
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CPT 99469
5 of 25 sample ratesHigher to lower in this preview
Hieucam Phan
$2,293.46Published rateAmy Dipietro
$813.27Published rateBarsam Gharagozlou
Barsam Gharagozlou Md Inc
$615.61Published rateCaitlin Renn
Adventist Health Physicans Network
$493.25Published rateAlice Abrahamian
Alice Abrahamian Md A Medical Corporation
$337.50Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 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 |
| 99478-CPT | Low | Subsequent Intensive Care Per, 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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Frequently Asked Questions
To get an estimate for a specific medical procedure, especially if you have the CPT code and your location, you can use tools designed for price transparency. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get an idea of potential costs. It's also advisable to contact your healthcare provider's billing department and your insurance company for their specific rates and coverage details.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers (like insurance companies) for accurate billing and record-keeping. They are essential for communicating what services were performed during an encounter.
Medical costs can vary significantly due to several factors, including the specific healthcare provider or facility, geographic location, negotiated rates with different insurance companies, the complexity of the procedure, and whether the service is in-network or out-of-network. Different facilities may also have varying overheads and technologies, influencing their pricing.
To determine if your insurance covers a specific procedure, you should directly contact your insurance provider. They can inform you about your specific plan benefits, deductibles, co-pays, and any prior authorization requirements. While Payerprice can help you understand the potential cost of a procedure based on CPT code and location, your insurance company is the definitive source for coverage details under your specific policy.
If you receive an unexpected medical bill, first review it carefully for accuracy. Compare it against any Explanation of Benefits (EOB) from your insurance company. Contact the provider's billing department to clarify any discrepancies or questions. If you want to verify if the charges are reasonable for your area and the services rendered, you can use tools like Payerprice to look up fee schedules for the CPT codes listed on your bill, which can help you in discussions with your provider or insurer.