CPT 99468: Initial Neonatal Critical Care Evaluation
Medicare pays $795 and commercial payers pay $1279 on average nationally for this procedure.
CPT code 99468 describes the provider’s evaluation and management of the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting, representing an initial neonatal critical care service delivered in an inpatient neonatal intensive care unit or similar critical care environment.
Customize your policy alerts
Sign up for cpt 99468 policy alerts
Get alerted when payer policies referencing 99468 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 99468: BUCA’s mean commercial rate is $1,279.20 versus Medicare’s mean of $795.00, a spread of $484.20. Blue Cross Blue Shield (BCBS), Cigna, UnitedHealth Group, Aetna and BUCA all show mean rates clustered in the $1,100–$1,450 range, reinforcing that commercial payers pay materially more than Medicare on average.
Dispersion varies notably by payer. Calculated IQRs (P75–P25) are tightest for Blue Cross Blue Shield at $375.30 and widest for Aetna at $1,052.60; UnitedHealth Group ($978.00), Cigna ($677.50) and BUCA ($658.40) fall between those extremes. This indicates that Aetna exhibits the largest mid‑range variability, while Blue Cross Blue Shield has the most compressed commercial rate distribution.