2025 CPT code 99469
Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger.
Modifiers may be applicable in certain circumstances. For example, modifier 25 may be appended if a significant, separately identifiable E/M service is provided by the same physician on the same day.
Medical necessity must be established by documenting the neonate's critical illness and the need for continuous intensive care services in the NICU. Documentation should clearly indicate the severity of the condition, including physiological instability, and the intensity of services required.
The physician or other qualified healthcare professional providing and managing the subsequent critical care services for the critically ill or injured neonate, including assessment, intervention, and management plans, typically in a neonatal intensive care unit (NICU) setting.
In simple words: This code covers the daily care provided to a critically ill newborn, up to 28 days old, who is in a neonatal intensive care unit (NICU) and needs close monitoring and frequent medical attention, after the initial day of admission.
This code encompasses the subsequent hospital inpatient care for a critically ill neonate, aged 28 days or less, requiring intensive observation, frequent interventions, and other intensive care services.
Example 1: A premature infant, born at 26 weeks, continues to receive critical care in the NICU on the second day of admission for respiratory distress syndrome., A two-week-old neonate with congenital heart disease remains critically ill and requires ongoing critical care management in the NICU., A newborn, diagnosed with sepsis, requires continued critical care support and monitoring in the NICU on their fifth day of admission.
Documentation should support the neonate's critical condition requiring ongoing intensive care, including details of interventions, assessments, and treatment plans.
** The procedures included in the neonatal critical care codes (e.g., invasive or non-invasive electronic monitoring, vascular access procedures, airway and ventilation management, transfusion of blood components, bladder catheterization, lumbar puncture) are not separately reported when 99469 is billed. However, any services performed which are not specifically listed as included may be reported separately.
- Revenue Code: M2C - HOSPITAL VISIT - CRITICAL CARE
- Payment Status: Active
- Specialties:Neonatology, Critical Care Medicine, Pediatrics
- Place of Service:Inpatient Hospital