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See a sample rate comparisonCPT 99460 Fee Schedule
Last Verified: October 2026
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.
Initial Hospital Or Birthing C, Initial Hospital Or Birthing Center Care Per Dayfor Evaluation And Management Of Normal Newborn I Nfant
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Newborn Care Services |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $80.83 national non-facility rate (2026) · View Medicare rates for 99460 |
| Medicaid Fee Schedule | $66.94 median of the 8 states in the free preview · View Medicaid rates for 99460 |
National average reimbursement for CPT 99460 by major payers:
$112.99
$108.66
$108.53
$146.64
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CPT 99460
5 of 25 sample ratesHigher to lower in this preview
Michael Yogman
$320.48Published rateIsabella Joslin
Brookline Pediatrics, LLC
$188.97Published rateRuby Shah
Vitality Weight Loss And Wellness Institute PLLC
$112.00Published rateParul Garg
Galveston Health Partnership
$87.69Published rateEric Tiblier
Dr. Eric Tiblier, P.A.
$64.40Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 C, Initial Hospital Or Birthing Center Care Per Dayfor Evaluation And Management Of Normal Newborn I Nfant |
| 99461-CPT | Low | Initial Care Per Day For Eva, Initial Care Per Day For Evaluation And Management Of Normal Newborn Infant Seen In Other Than Hospital Or Birthing Center |
| 99462-CPT | Low | Newborn Exam And Care, Daily Exam Monitoring And Care Of A Newborn In An Inpatient Facility Such As A Hospital Or Birthing Center. |
| 99463-CPT | Low | Initial Hospital Or Birthing C, Initial Hospital Or Birthing Center Care Per Dayfor Evaluation And Management Of Normal Newborn I Nfant 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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