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See a sample rate comparisonCPT 99465 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.
Deliverybirthing Room Resusci, Deliverybirthing Room Resuscitation Provision Ofpositive Pressure Ventilation Andor Chest Compre Ssions In The Presence Of Acute Inadequate Ventilation Andor Cardiac Output
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Delivery/Birthing Room Attendance and Resuscitation Services |
| Common Place of Service | 21 - Inpatient Hospital 99 - Other POS |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day SA |
| Complexity Level | Low |
| Medicare Fee Schedule | $123.58 national non-facility rate (2026) · View Medicare rates for 99465 |
| Medicaid Fee Schedule | $108.88 median of the 8 states in the free preview · View Medicaid rates for 99465 |
National average reimbursement for CPT 99465 by major payers:
$187.83
$185.85
$186.84
$236.53
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CPT 99465
5 of 25 sample ratesHigher to lower in this preview
Anita Pairitz
Indiana University Health Southern Indiana Physicians
$379.91Published rateGirishkumar Dhorajia
Carle West Physician Group Inc
$259.23Published rateMatthew Atienza
Advocate Health And Hospitals Corporation
$220.10Published rateAshley Boyle
Town Center Orthopaedic Associates, P.C.
$180.61Published rateElizabeth Bay
Northern Arizona Healthcare Corporation
$119.76Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99465 vs. Other Delivery/Birthing Room Attendance and Resuscitation Services Codes
The CPT 99465 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 99465 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. |
| 99465-CPT | Low | Deliverybirthing Room Resusci, Deliverybirthing Room Resuscitation Provision Ofpositive Pressure Ventilation Andor Chest Compre Ssions In The Presence Of Acute Inadequate Ventilation Andor Cardiac Output |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99465. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99465 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
Understanding healthcare costs upfront is important for financial planning. While you can ask your provider for an estimate, for more specific, localized price estimates based on CPT codes, it's recommended to use a specialized fee schedule lookup tool. This allows you to compare prices and better understand potential costs.
CPT stands for Current Procedural Terminology. These are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. CPT codes are crucial because they provide a uniform way to identify services for billing, insurance claims, and price transparency. Knowing the CPT code for a procedure is key to accurately researching its typical cost.
For detailed and localized price information using CPT codes, you should utilize a specialized fee schedule lookup tool. Payerprice offers a tool where you can search with a CPT code and your specific location to find relevant pricing data for various medical services.
To determine your insurance coverage and potential out-of-pocket costs, it's best to contact your insurance provider directly. They can explain your specific plan's benefits, deductibles, co-pays, and whether a service is covered. You will likely need to provide them with the CPT code for the service. After understanding your coverage, you can use Payerprice's fee schedule lookup tool to get an estimate of typical service prices in your area, which can help you anticipate your potential out-of-pocket expenses.