NICU Inpatient Level of Care

All Neonatal Intensive Care Unit (NICU) admissions require precertification for the appropriate NICU level of care throughout the inpatient stay and until the newborn is discharged.

• Based on medical necessity, a NICU admission can potentially be certified for more than one level of care. 
• The four NICU levels of care are represented by a unique revenue code and should be billed with the level of care that was approved during the utilization review process. 
• If the claim is billed at a higher level of care than the level approved in the authorization, the claim will be denied.   
• If the provider disagrees, please follow the appeal or resubmission process. 

Note: All certification requirements for out-of-state Blue Cross and/or Blue Shield patients are dictated by the member’s Blue Plan.