CPT 99464 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 • Delivery/Birthing Room Attendance and Resuscitation Services |
| Common Place of Service | • 21 - Inpatient Hospital • None |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • SA |
| Complexity Level | Low |
National average reimbursement for CPT 99464 by major payers:
$100.07
$93.90
$97.32
$123.70
| 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 99464 | ||||||
United | 99464 | $167.97 | 1285730440 - REI TOSU | 952321786 - CHILDRENS HOSPITAL OF ORANGE COUNTY | CA | Pediatrics Physician (208000000X) |
United | 99464 | $127.94 | 1487722799 - MICHAEL SACHS | 300713457 - (CA) PREMIER PEDIATRICS BEVERLY HILLS | CA | Pediatrics Physician (208000000X) |
United | 99464 | $195.55 | 1811423072 - LILY PHAM | 951691313 - RADY CHILDRENS HOSPITAL-SAN DIEGO | CA | Pediatrics Physician (208000000X) |
United | 99464 | $431.00 | 1215514849 - KELLY HILK | 943281657 | CA | Pediatrics Physician (208000000X) |
United | 99464 | $375.72 | 1437310299 - LEIAN CHEN | 954373071 | CA | Pediatrics Physician (208000000X) |
United | 99464 | $61.18 | 1699055293 - CASEY JOHNSTON | 680259045 - (CA) MENDOCINO COMMUNITY HEALTH CLINIC INC | CA | Pediatrics Physician (208000000X) |
United | 99464 | $268.01 | 1700317690 - MANAS TETARBE | 954474603 - PEDIATRIX MEDICAL GROUP OF CALIFORNIA A PROFESSIONAL CORPORATION | CA | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 99464 | $74.73 | 1518098961 - LYNN RAMIREZ | 943281666 | CA | Pediatrics Physician (208000000X) |
United | 99464 | $122.37 | 1306367982 - REBECCA BOENING | 941603784 - ENLOE MEDICAL CENTER | CA | Pediatrics Physician (208000000X) |
United | 99464 | $68.62 | 1962063743 - POOJA KUMAR | 942196086 - GOLDEN VALLEY HEALTH CENTERS | CA | Pediatrics Physician (208000000X) |
United | 99464 | $97.80 | 1720179799 - FOSTER CITY PEDIATRIC MEDICAL GROUP INC | 943283004 - (CA) FOSTER CITY PEDIATRIC MEDICAL GROUP INC. | CA | Pediatrics Physician (208000000X) |
United | 99464 | $71.11 | 1912914755 - HO CHIE TSAI | 943281666 | CA | Pediatrics Physician (208000000X) |
United | 99464 | $268.01 | 1477744480 - ALISON SHUMAN | 954474603 - PEDIATRIX MEDICAL GROUP OF CALIFORNIA A PROFESSIONAL CORPORATION | CA | Pediatrics Physician (208000000X) |
United | 99464 | $73.52 | 1578662490 - KASEMSANT HANSUVADHA | 770075259 | CA | Pediatrics Physician (208000000X) |
United | 99464 | $256.98 | 1720199722 - ERICA GOLDMAN | 941156581 - SUTTER BAY MEDICAL FOUNDATION | CA | 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 |
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CPT 99464 vs. Other Delivery/Birthing Room Attendance and Resuscitation Services Codes
The CPT 99464 code is part of the Evaluation and Management services used for Delivery/Birthing Room Attendance and Resuscitation 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 99464 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 |
| 99464-CPT | Low | Attendance At Delivery (When Requested By The Delivering Physician Or Other Qualified Health Care Professional) And Initial Stabilization Of Newborn (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99464. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99464 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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