CPT 99462 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 • 50 - Federally Qualified Health Center • 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 99462 by major payers:
$51.84
$49.68
$49.61
$70.98
| 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 99462 | ||||||
United | 99462 | $42.27 | 1194795310 - LITTLE ELM MEDICAL CLINIC PA | 752867549 - (TX) LITTLE ELM MEDICAL CLINIC PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $51.54 | 1700087210 - ATIF RIZWAN | 756003935 | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $42.95 | 1023678349 - ROQUE MIFUJI LIRA | 800725733 - (TX) HNI MEDICAL SERVICES | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $148.27 | 1053452458 - SCOTT PAUL | 43496618 - (MA) MILTON PEDIATRIC ASSOCIATES, LLC | MA | Pediatrics Physician (208000000X) |
United | 99462 | $53.16 | 1275565236 - KOTA REDDY | 481254491 - (TX) KOTA JAGDISH REDDY, M.D., P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99462 | $148.27 | 1316137458 - FRANCHEYSKA SILFA MAZARA | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99462 | $50.97 | 1427586445 - ROXANNE BAUTISTA | 912146629 - SOUND INPATIENT PHYSICIANS, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $31.86 | 1023581006 - LEON S TIO MD PA, CLOVER INTERNAL MEDICINE ASSOCIATES | 820738699 - (TX) LEON S TIO MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $34.36 | 1154384881 - FARHANA KAZI | 472426594 - (TX) AFFINITY HEART CARE PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99462 | $45.09 | 1215946637 - RELVERT COE | 752441443 - (TX) INTERNAL MEDICINE ASSOCIATES OF PALESTINE PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $36.11 | 1407292352 - MICHAEL ARRIAGA | 814217682 - (TX) MICHAEL ARRIAGA MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $32.20 | 1710977913 - ROUSSEL CLEMENT | 853987542 - (TX) EVEREST PRIMARY CARE MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $51.50 | 1790755163 - SHAHRZAD SOROURBAKHSH | 260089066 | MA | Pediatrics Physician (208000000X) |
United | 99462 | $42.36 | 1982918025 - RINAL PATEL | 841881152 - (TX) RINAL PATEL 30 MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99462 | $82.02 | 1760713424 - NISHANT JAYASWAL | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
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 99462 vs. Other Newborn Care Services Codes
The CPT 99462 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 99462 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 99462. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99462 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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