CPT 99463 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 • 99 - Other POS |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
National average reimbursement for CPT 99463 by major payers:
$136.16
$130.48
$128.64
$173.16
| 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 99463 | ||||||
United | 99463 | $101.33 | 1770550931 - JONAS GARCIA | 760176665 - (TX) JONAS GARCIA, M.D. AND ASSOCIATES 401(K) PLAN | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $169.80 | 1205871845 - CHRISHANTHI PERERA | 264562522 - SETON FAMILY OF DOCTORS | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $168.89 | 1477547875 - SATISH VAYUVEGULA | 364407123 - (TN) TENNESSEE PHLEBOLOGY, P.C. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99463 | $106.52 | 1568710010 - KAZUE OKAJIMA | 752668018 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99463 | $120.73 | 1477757730 - EMMANUEL MANTILLA | 352526373 - ACCLAIM PHYSICIAN GROUP INC | TX | Neurology Physician (2084N0400X) |
United | 99463 | $175.66 | 1689964215 - KYLE GUMMELT | 752600832 - (TX) HEALTHTEXASMED PROVIDER | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $84.44 | 1023158409 - HARPAUL GILL | 270786745 - (TX) GILL NEUROSCIENCES PA | TX | Neurology Physician (2084N0400X) |
United | 99463 | $278.35 | 1205246931 - JEOMI OKWARA | 756002868 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99463 | $84.44 | 1215381900 - REMY ZOCKAZOCK | 922358069 - (TX) WALLER URGENT CARE INC | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $152.88 | 1336386218 - DOMINIQUE KALIL | 880645926 - HEALTHY LIFE PHYSICIANS GROUP PACIFIC NORTHWEST PC | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $219.38 | 1982686317 - RANDA REITMAN | 43541176 - (MA) CAPE COD PEDIATRICS | MA | Pediatrics Physician (208000000X) |
United | 99463 | $90.08 | 1174575104 - MARIO LAMMOGLIA | 742892527 - (TX) MARIO A LAMMOGLIA MD PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99463 | $101.33 | 1154339380 - ANTHONY ASISTIDO | 881012516 - (TX) INPATIENT CONSULTANTS OF CORPUS CHRISTI PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99463 | $196.74 | 1063868677 - YU-HSUAN LIAO | 111871039 - (NY) ST CHARLES HOSPITAL CORP | TX | Neurology Physician (2084N0400X) |
United | 99463 | $101.33 | 1275534109 - MICHELLE SCANLAN | 742518083 - (TX) PASTEUR MEDICAL ASSOCIATES PA | 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 99463 vs. Other Newborn Care Services Codes
The CPT 99463 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 99463 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 | Low | Initial Hospital Or Birthing Center Care, Per Day, For E&M Of Normal Newborn Infant |
| 99461 | Low | Initial Care, Per Day, For Evaluation And Management Of Normal Newborn Infant Seen In Other Than Hospital Or Birthing Center |
| 99462 | Low | Subsequent Hospital Care, Per Day, For E&M Of Normal Newborn |
| 99463 | 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 99463. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99463 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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