Neonatal Intensive Care Unit (NICU)

These fees apply to the services of being in constant or periodic attendance during a one day period, to provide all aspects of care to patients in Neonatal Intensive Care Units designated by the DHCS. There are three levels of care depending upon the procedures performed.

These are team fees which apply to Neonatologists/Pediatricians/Anaesthesiologists providing complete daily care and should be claimed by the physician in charge of the patient. The daily fee includes the initial consultation, subsequent assessments, and the ongoing monitoring of the patient’s condition, including the following procedures as required:

(a) insertion of IVs, arterial and CVP lines, 

(b) use of pressure infusion sets, 

(c) endotracheal intubation and tracheobronchial toilet, 

(d) insertion and maintenance of urinary catheters and nasogastric tubes,

(e) securing and interpreting the results of arterial blood gas samples, and 

(f) the use of artificial ventilation.

These fees may be claimed in the post-operative period for patients receiving either Level A or B care. Level C care cannot be claimed for post-operative infants.

Physicians not part of the daily care team, whose additional expertise is required, may bill for each item of service performed, including Concurrent Care (fee code 51790).

When a patient’s care is transferred to a higher or lower level, the second day rate for that level applies. However, in any one period of NICU care, the first day rate for the highest level is payable for the date the patient transferred to that level. Only one first day rate is payable per NICU period.

Consultations or other assessments are not payable on transfers out of a NICU to the physician who cared for the patient in the NICU. However, consultations or assessments consistent with Preamble definitions are payable to other physicians, including those in the same specialty as the NICU physician, who render subsequent care to the patient transferred out of the NICU. 

When a patient is readmitted to the NICU within 48 hours of discharge, second day benefits apply. After 48 hours, first day benefits apply.

All claims for NICU must contain the facility number of the hospital in which the service was provided.