2025 CPT code 99480
Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2501-5000 grams).
Medical necessity must be clearly documented for the intensive level of care. The documentation must support the ongoing need for frequent interventions and specialized monitoring beyond routine newborn care, even though the infant is not critically ill. This might include ongoing issues with feeding, temperature regulation, oxygen saturation, or other conditions that require close medical supervision.
The physician or other qualified healthcare professional provides direct supervision and direction of the continuing intensive care required by the recovering infant.
- Evaluation and Management > Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
In simple words: This code covers the doctor's supervision of a recovering baby (weighing between 2501 and 5000 grams) in the hospital who needs close monitoring and frequent medical attention, but is not critically ill.It's used for each day the baby receives this level of care after the first day.
This code is used for the subsequent hospital days after the initial day of intensive care for an infant who does not meet the criteria for critical care but still requires intensive observation, frequent interventions, and other intensive care services. The infant's present body weight should be between 2501 and 5000 grams. This includes infants who require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct supervision of the physician or other qualified health care professional.This code can only be reported once per day, per patient, in a given facility, and should not be reported alongside the bundled procedures included in the neonatal intensive care service.
Example 1: A 2-day-old infant, born prematurely and weighing 3000 grams, is recovering in the hospital but still requires intensive monitoring and frequent interventions such as intravenous fluids and oxygen support.The physician directs their care, and this code (99480) is reported., A 10-day-old infant, weighing 4000 grams, is no longer considered critically ill but requires ongoing intensive observation, frequent vital sign checks, and adjustments to their nutritional plan. The physician oversees their care, and code 99480 is billed., A recovering newborn, 25 days old and weighing 2600 grams, is transferred from the NICU to a step-down unit and requires ongoing intensive monitoring, though they no longer meet the definition of critically ill. Code 99480 is reported for each subsequent day of intensive care.
Documentation should support the medical necessity of the intensive care services provided, including the infant's present body weight (between 2501 and 5000 grams), and the specific interventions and monitoring required, such as cardiac and respiratory monitoring, vital signs, nutritional adjustments, and observation frequency.
- Revenue Code: M2C
- Specialties:Neonatology, Pediatrics
- Place of Service:Inpatient Hospital