CPT 99461 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 | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • EP - Residential facility to Physician's office |
| Complexity Level | Low |
National average reimbursement for CPT 99461 by major payers:
$116.56
$113.91
$102.57
$153.00
| 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 99461 | ||||||
United | 99461 | $147.77 | 1306097084 - SRIVADEE ORAVIVATTANAKUL | 741625143 - (TX) ADC PHYSICIANS, P.A. | TX | Neurology Physician (2084N0400X) |
United | 99461 | $185.80 | 1558945386 - ISABELLA JOSLIN | 832037903 - (MA) BROOKLINE PEDIATRICS, LLC | MA | Pediatrics Physician (208000000X) |
United | 99461 | $99.09 | 1013081223 - PEDIATRIC HEALTHCARE ASSOCIATES INC | 204716785 - (MA) PEDIATRIC HEALTHCARE ASSOCIATES INC. | MA | Pediatrics Physician (208000000X) |
United | 99461 | $127.63 | 1356515787 - SENDIL KUMAR HARI PRASAD | 760010407 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99461 | $168.25 | 1821668310 - BHUPENDAR TAYAL | 204881619 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99461 | $81.69 | 1467433375 - LYDIA WOLF | 203454656 | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $186.52 | 1073598413 - SHAMIM KHAMBATI | 208866890 - (TX) TEXAS MEDICAL GROUP, PA DBA HEALTHC | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $74.19 | 1861505539 - RAMON PINEDA | 760367510 - (TX) RAMON A PINEDA MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $154.80 | 1134573637 - DANIEL JIPESCU | 741857100 | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $153.03 | 1316987779 - AMAN SIBAL | 742967081 - (TX) HILLCREST PHYSICIAN SERVICES | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $97.38 | 1932147246 - ALFREDO JIMENEZ | 752233700 - (TX) NORTH TEXAS HEART CENTER, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99461 | $185.80 | 1083300271 - KELLY FLAHERTY | 42730094 - (MA) WAREHAM PEDIATRIC ASSOCIATES, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99461 | $153.03 | 1871859520 - ADRIENNE SCOTT | 742958277 - SCOTT & WHITE CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99461 | $138.86 | 1437115672 - JO ELLEN ALTSCHAEFL | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99461 | $177.97 | 1275507360 - MELISSA MAURO-SMALL | 43306782 - (MA) SIGNATURE HEALTHCARE MEDICAL GROUP INC | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 99461 vs. Other Newborn Care Services Codes
The CPT 99461 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 99461 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 99461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99461 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99461) and we'll show you how you compare in 15 minutes or less.