NICU Inpatient Level of Care

Policy Number: GP-I-001

Last Updated: Sept. 8, 2022 

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.