Pediatric and Neonatal Critical Care CPT codes - covered by Medicaid

Pediatric and Neonatal Critical Care

99468 Initial Inpatient Neonatal Critical Care, per day for the evaluation and management of
a critically ill neonate, 28 days of age or less

Criteria - Not valid for 29 days or older, can be billed by any physician provider type

99469 Subsequent Inpatient Neonatal  Critical Care, per day for the evaluation and management of
a critically ill neonate, 28 days of age or less

Criteria - Not valid for ages 29 days or older, can be billed by any physician provider type


99471 Initial Inpatient Pediatric Critical Care, per day for the evaluation and management of
a critically ill infant or young child, 29 days through 24 months of age



Criteria  - Not valid for 28 days or less, can be billed by any physician provider type

RESTRICTIONS:

No individual procedures related to critical care may be billed in addition to procedure codes 99468-99476 except:

• Chest tube placement
• Pericardiocentesis or thoacentesis
• Intracranial taps
• Initial hospital care history and physical or EPSDT screen may be billed in conjunction with 99468. Both may not be billed.

NOTE: One EPSDT screen for the hospitalization will encompass all diagnoses identified during the hospital stay for referral purposes.

• Standby (99360), resuscitation (99465), or attendance at delivery (99464) may be billed in addition to critical care. Only one of these codes may be billed in addition to neonatal intensive care
critical care codes.

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