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See a sample rate comparisonCPT 99462 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.
Newborn Exam And Care, Daily Exam Monitoring And Care Of A Newborn In An Inpatient Facility Such As A Hospital Or Birthing Center.
| 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 | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.41 national non-facility rate (2026) · View Medicare rates for 99462 |
| Medicaid Fee Schedule | $28.74 median of the 8 states in the free preview · View Medicaid rates for 99462 |
National average reimbursement for CPT 99462 by major payers:
$51.84
$49.68
$49.61
$71.38
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CPT 99462
5 of 25 sample ratesHigher to lower in this preview
Scott Paul
Milton Pediatric Associates, LLC
$148.27Published rateHaydar Alamiri
Memorial Hermann Medical Group
$58.75Published rateRoxanne Bautista
Sound Inpatient Physicians, PLLC
$50.97Published rateMichael Arriaga
Michael Arriaga Md PA
$36.11Published rateLeon S Tio Md PA, Clover Internal Medicine Associates
Leon S Tio Md PA
$31.86Published rate
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See a sample payer proposalCPT 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 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 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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Frequently Asked Questions
To find the cost of a medical procedure, you can start by asking your healthcare provider for an estimate. For a more detailed and specific price lookup based on a CPT code and your specific location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that can help you understand potential costs.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for billing and for accurately identifying the specific services you receive, which in turn helps in looking up their costs.
Fee schedules for medical services can be complex and vary significantly by payer, provider, and geographic location. While some general information might be available, for a specific fee schedule lookup based on a CPT code and your particular location, it's best to use specialized tools. Payerprice offers a fee schedule lookup tool designed to help users search for this specific information.
Prices for the same medical procedure can vary significantly due to multiple factors. These include the healthcare provider's individual charges, negotiated rates with different insurance companies, the specific geographic location, the type of facility where the service is rendered (e.g., hospital vs. outpatient clinic), and the patient's insurance plan benefits and deductible status.
Comparing prices for healthcare services effectively involves looking up specific procedure codes (CPT codes) for different providers and locations. Tools like Payerprice are specifically designed to assist consumers with this. By using Payerprice's fee schedule lookup tool, you can search with a CPT code and your specific location to gather pricing information and make more informed decisions about your healthcare.