Health Evidence Review Commission's Value-based Benefits Subcommittee

Neonatal Line Scoring (does not include congenital heart disease or other congenital anomaly lines)
Line Score Comments
2 BIRTH OF INFANT 5000 Hand moved to line position
10 GALACTOSEMIA 5625 Affects for extended period
11 RESPIRATORY CONDITIONS OF FETUS AND NEWBORN 5600 Do not merge—has unique
treatment CPTs
13 CONGENITAL HYPOTHYROIDISM 4875 Affects for extended period
14 PHENYLKETONURIA (PKU) 4875 Affects for extended period
15 CONGENITAL INFECTIOUS DISEASES 4800 Affects for extended period
16 CONGENITAL SYPHILIS 4800 Affects for extended period
17 VERY LOW BIRTH WEIGHT (UNDER 1500 GRAMS) 4800
18 NEONATAL MYASTHENIA GRAVIS 4400
19 FEEDING PROBLEMS IN NEWBORNS 4400
21 SYNDROME OF "INFANT OF A DIABETIC MOTHER" 4000
AND NEONATAL HYPOGLYCEMIA
22 OMPHALITIS OF THE NEWBORN AND NEONATAL 4000
INFECTIVE MASTITIS
23 LOW BIRTH WEIGHT (1500-2500 GRAMS) 4000
27 INTRACRANIAL HEMORRHAGES; CEREBRAL
3600
CONVULSIONS, DEPRESSION, COMA, AND OTHER
ABNORMAL CERERAL SIGNS OF THE NEWBORN
31 DRUG WITHDRAWAL SYNDROME IN NEWBORN 3300
34 SEVERE BIRTH TRAUMA FOR BABY 3300 Diagnoses overlap with line 27
35 NEONATAL THYROTOXICOSIS 3200
36 HEMATOLOGICAL DISORDERS OF FETUS AND
3200
NEBORN
43 DISORDERS RELATING TO LONG GESTATION AND 3000
HIGH BIRTHWEIGHT
45 HYPOCALCEMIA, HYPOMAGNESEMIA AND OTHER 3000
ENDOCRINE AND METABOLIC DISTURBANCES SPECIFIC
TO THE FETUS AND NEWBORN
77 POLYCYTHEMIA NEONATORUM, SYMPTOMATIC 2500
92 NECROTIZING ENTEROCOLITIS IN FETUS OR
NEWBORN
2400 Do not merge—has unique
treatment CPTs
106 HEMOLYTIC DISEASE DUE TO ISOIMMUNIZATION,
ANEMIA DUE TO TRANSPLACENTAL HEMORRHAGE, AND
FETAL AND NEONATAL JAUNDICE
146 CONDITIONS INVOLVING THE TEMPERATURE 2000
REGULATION OF NEWBORNS
149 ANEMIA OF PREMATURITY OR TRANSIENT
2000
NEONATAL NEUTROPENIA
283 HYDROPS FETALIS 1200
2240 Do not merge—has unique
treatment CPTs