Which CPT codes are used for neonatal critical care billing?

Common neonatal critical care CPT codes include 99468 (initial inpatient neonatal critical care), 99469 (subsequent neonatal critical care), and related pediatric codes. Newborn care codes 99460–99463 apply to routine newborn services depending on setting and complexity.

Do you handle both hospital and private neonatology billing?

Yes. Sirius Solutions Global supports both hospital-based NICU billing and private neonatology groups, managing professional, facility, and ancillary billing processes end-to-end.

How can Sirius Solutions Global improve our NICU collections?

We improve collections through accurate NICU coding, denial trend analytics, faster follow-up, and payer-specific rule management—typically increasing clean-claim rates and reducing A/R days within 60–90 days.

Is your neonatology billing team certified?

Yes. Our billing specialists hold AAPC and AHIMA certifications, with experience in neonatal and pediatric critical care coding and compliance audits.

Can you help with NICU audit defense?

Absolutely. We prepare detailed documentation packets and clinical summaries to support audits, appeals, and payer recoupment reviews to protect your NICU revenue.

Neonatology Billing Services

Expert neonatal billing for NICUs and newborn practices fewer denials, faster cash flow, clinical-grade compliance.
Caring for the tiniest patients means long days, intense clinical focus, and high-stakes documentation. You shouldn’t have to lose revenue over paperwork. At Sirius Solutions Global, we specialize in neonatology billing NICU-focused coding, payer-specific filings, and clinical documentation audits so your clinical team can stay at the bedside while we protect your revenue.

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Our Neonatology Billing Services

We deliver full-cycle NICU revenue management clinical expertise + technical workflows.

1) Front-end verification & pre-certification

Insurance eligibility and benefits verification before admission or high-cost interventions.
Prior authorization support for procedures and specialty services that require pre-cert.
Payer rule checklist for NICU-level coverage and inpatient criteria.

2) Clinical coding & charge capture

Accurate capture of newborn care (99460–99463), initial & subsequent neonatal critical care (99468–99476), and procedure-specific CPTs.
Capture ventilator management, surfactant administration, central lines, parenteral nutrition, and dialysis codes with proper modifiers and documentation linkage.
Audit and correct coder-physician documentation mismatches daily.

3) Clean claim submission & proactive follow-up

Electronic claims with payer-specific templates to reduce rejects.
Automated aging workflows: escalate unpaid claims at 30/60/90 days with clinical backup for appeals.

4) Denial prevention & appeals

Root-cause denial analytics (e.g., documentation missing, units/days underreported, overlapping provider claims).
Clinically supported appeals and peer-to-peer facilitation when necessary.

5) A/R management & KPI dashboards

Weekly dashboards: clean-claim rate, denial rate by payer, A/R by >30/60/90, days-to-pay, and net collection rate.
Actionable playbook for addressing high-denial codes and payers.

6) Compliance & audit readiness

NICU-specific documentation checklists: daily progress notes, critical care criteria, procedure notes with start/stop times, informed consents, and medication logs.
Audit support and recoupment defense prep.

Benefits of Partnering with Sirius Solutions Global

✅ Higher Clean Claim Rate – Over 99% first-pass claim acceptance.
✅ Faster Reimbursements – Reduced payment turnaround times.
✅ Revenue Growth – Capture every dollar with accurate coding and denial recovery.
✅ Reduced Administrative Burden – Focus on patient care while we handle billing.
✅ Full Transparency – Customized reporting and analytics for financial insights.
✅ 24/7 Support – A dedicated neonatology billing team available whenever you need.

Why neonatology billing is different

Neonatal billing isn’t simply “pediatric billing.” NICU work requires detailed daily documentation, time-based critical-care reporting, and coordination across providers and facility billing. Mistakes cost you more than money they create administrative burden, delay care planning, and erode staff morale.

Daily critical-care reporting: Neonatal critical-care codes (e.g., 99468–99476 and related pediatric critical care codes) are billed per day and require clear criteria for initial vs subsequent days. Billing the wrong day or level invites denials.
Multiple billing layers: Neonatal care often results in physician professional claims, facility claims, and ancillary charges (respiratory supplies, pharmacy, labs). Coordinating all layers prevents duplicate or missed revenue capture.
Payer-level rules & NICU level definitions: Many insurers define NICU levels or coverage differently what counts as Level II vs Level III care affects reimbursement and documentation expectations. We treat payer rules as living documents.

Infographic showing common NICU billing challenges including critical care coding, ventilator management, and multiple providers, with Sirius Solutions Global's specific solutions.

Common NICU billing scenarios & our solutions

Scenario A — Daily Critical Care (Initial vs Subsequent)
Problem: A neonate’s critical-care days are logged inconsistently; the practice bills initial-care codes for all admission days.
Solution: We train coders and clinicians on initial vs subsequent day criteria, implement daily progress-note templates aligned to CPT criteria, and set claim-flagging rules to prevent overbilling or underbilling.
Scenario B — Ventilator & Respiratory Management
Problem: Ventilator time, oxygen therapy, or CPAP documentation is insufficient to justify respiratory procedure codes.
Solution: We help standardize respiratory flow-sheets and translate them into claim-ready documentation capturing start/stop times, device mode/duration, and physician orders to support coding.
Scenario C — Multiple Providers & Duplicate Billing
Problem: Hospitalist, neonatologist, and subspecialist claims overlap or conflict, triggering denials.
Solution: We run cross-provider conflict checks, reconcile charge windows, and document who provided what, when eliminating billing overlap and streamlining professional vs facility splits.
Scenario D — Long-stay NICU & Bundling
Problem: Long-stay claims get denied due to incorrect bundling of services or missed daily modifiers.
Solution: We audit long-stay patterns, ensure correct day-by-day reporting, and apply appropriate modifiers or split-billing when necessary.

Typical outcomes (what practices commonly see)

Reduced denial rate within the first 60–90 days by fixing documentation and payer-template issues.
Shorter A/R days through aggressive follow-up and prioritized appeals.
Higher net collections from better capture of ventilator/therapy/procedure charges and cleaner claims.

List of typical outcomes for neonatology practices using Sirius Solutions Global, including reduced denial rates, shorter accounts receivable days, and higher net collections.

Description of AI-powered neonatology billing solutions featuring automated coding, denial prediction, revenue optimization, and NICU-specific compliance checks.

AI & Technology in Neonatology Billing

To streamline sophisticated neonatology billing, we at Sirius Solutions Global include artificial intelligence-powered billing tools. Our AI-driven technology helps with:

Automated coding suggestions to decrease human mistakes.
Prevent rejections before submitting with predictive denial analysis.
Revenue cycle optimization based on data enhances collections.
Real-time compliance checks for NICU-specific coding and payer guidelines.

For neonatology practices, this guarantees quicker payouts, fewer denials, and greater profitability.

Why Choose Sirius Solutions Global for Neonatology Billing?

Specialized neonatology coders with decades of combined experience.
Confirmed competence in managing NICU hospital bills and private neonatology clinics.
Advanced artificial intelligence includes billing systems for correctness and efficiency.
Tailored billing strategies matching every neonatology clinic's particular demands.
With compliance and security our main focus, end-to-end RCM.

Quick Helpful Answers

Neonatology Billing FAQs

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Call to action for neonatology practices to partner with Sirius Solutions Global for AI-driven revenue cycle management to lower denials and boost earnings.

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Billing in neonatology calls for advanced technology, accuracy, and knowledge. To guarantee your practice grabs every dollar it earns, at Sirius Solutions Global we combine seasoned coders, AI-driven RCM tools, and strong healthcare expertise.

👉 While you concentrate on saving lives, we can help you lower denials, boost collections, and raise earnings.

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