CPT 99460 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Newborn Care Services |
| Common Place of Service | • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 99460 by major payers:
$112.99
$108.66
$108.53
$146.87
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99460 | ||||||
United | 99460 | $183.30 | 1316934441 - KATHERINE FRIAS | 272777455 | MA | Pediatrics Physician (208000000X) |
United | 99460 | $303.58 | 1215012000 - MANISHA SHAH | 391390638 - ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS INC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99460 | $87.69 | 1649894213 - MARRIYAM JAWAD | 270987765 | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $87.69 | 1609155001 - PARUL GARG | 813927873 - (TX) GALVESTON HEALTH PARTNERSHIP | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $167.63 | 1114053550 - TIYONNOH CASH | 900733283 | TX | Neurology Physician (2084N0400X) |
United | 99460 | $77.94 | 1508978214 - HUGO ROJAS | 742766753 - (TX) HUGO A ROJAS MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $81.55 | 1609373273 - DANIELA HAGENASR | 752931720 | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $279.16 | 1639518814 - TERESA VENTE | 131623978 | MA | Pediatrics Physician (208000000X) |
United | 99460 | $87.90 | 1982614251 - PAUL HARRIS | 842933777 - (TX) SYNAPSE HUMAN PERFORMANCE CENTERS INC | TX | Neurology Physician (2084N0400X) |
United | 99460 | $196.67 | 1073877700 - OLUBUKOLA OKORO | 812209406 - (TX) RESCUEMD PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $107.44 | 1740433069 - KRISTINE BERNARDO | 742932237 - (TX) COMMUNITY MEDICINE ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $77.41 | 1518969500 - RONALD PALANG | 134334288 | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $64.40 | 1649241803 - ERIC TIBLIER | 202640119 - (TX) DR. ERIC TIBLIER, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99460 | $112.00 | 1003134974 - RUBY SHAH | 811111364 - (TX) VITALITY WEIGHT LOSS AND WELLNESS INSTITUTE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99460 | $188.97 | 1558945386 - ISABELLA JOSLIN | 832037903 - (MA) BROOKLINE PEDIATRICS, LLC | MA | Pediatrics Physician (208000000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99460 vs. Other Newborn Care Services Codes
The CPT 99460 code is part of the Evaluation and Management services used for Newborn Care Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99460 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99460-CPT | Low | Initial Hospital Or Birthing Center Care, Per Day, For E&M Of Normal Newborn Infant |
| 99461-CPT | Low | Initial Care, Per Day, For Evaluation And Management Of Normal Newborn Infant Seen In Other Than Hospital Or Birthing Center |
| 99462-CPT | Low | Subsequent Hospital Care, Per Day, For E&M Of Normal Newborn |
| 99463-CPT | Low | Initial Hospital Or Birthing Center Care, Per Day, For Evaluation And Management Of Normal Newborn Infant Admitted And Discharged On The Same Date |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99460. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99460 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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