CPT 99460E&M

Init nb em per day hosp

CPT code 99460 is used when a pediatrician or other qualified healthcare provider performs the first evaluation and management of a healthy newborn on their day of birth in the hospital nursery.

Showing rates for

National Average

Base Medicare rate

$88.63

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.92

PE RVU (NF)

0.69

MP RVU

0.13

Total RVU

2.74

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 99460 only on the calendar date of birth; use 99462 for subsequent days in the hospital
Impact: Prevents denials for duplicate initial services; incorrect sequencing results in $88.63 denial
Document the exact time of birth and time of examination to support same-day billing when birth occurs late in the day
Impact: Critical for audits when exam occurs near midnight; missing time documentation causes 15-20% of claim denials
Never bill 99460 with 99464 (attendance at delivery) for the same provider on the same infant
Impact: These codes are mutually exclusive; billing both results in automatic denial of the higher-paid code
Ensure delivery provider and newborn care provider are different when billing both delivery management and 99460
Impact: Same provider cannot bill both mother's delivery and infant's initial care; causes bundling and potential $88.63 loss
Link to appropriate ICD-10 codes such as Z00.110 (newborn health exam) and Z38.x codes (liveborn infant)
Impact: Missing Z38 code triggers Medicare and commercial payer denials in 10-15% of claims
Document all required elements including gestational age, birth weight, Apgar scores, and parental counseling
Impact: Incomplete documentation is the #1 audit risk; missing elements can result in downcoding or full recoupment

Common denials

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Frequently asked questions

What is the difference between CPT 99460 and 99462?

CPT 99460 is used only for the initial hospital care on the newborn's date of birth, while 99462 is used for normal newborn care on subsequent days during the same hospitalization. 99460 pays $88.63, and both codes are reported once per calendar day.

Can you bill 99460 and circumcision on the same day?

Yes, you can bill both 99460 and a circumcision code (54150 or 54160) on the same day, but you must append modifier 25 to the 99460 code to indicate a separately identifiable evaluation and management service was performed.

How much does Medicare pay for CPT code 99460 in 2025?

Medicare pays $88.63 for CPT code 99460 in 2025 based on the national average non-facility rate. The code has 2.74 total RVUs (1.92 work RVU, 0.69 practice expense RVU, and 0.13 malpractice RVU).

Who can bill CPT code 99460?

Physicians (MD/DO) in pediatrics, family medicine, neonatology, or internal medicine-pediatrics can bill 99460, as well as qualified non-physician practitioners (nurse practitioners and physician assistants) with hospital privileges for newborn care.

Can the delivering obstetrician bill 99460 for the newborn?

No, the delivering obstetrician should not bill 99460 for routine newborn care. If the obstetrician provides attendance at delivery requiring resuscitation or other services, code 99464 should be used instead. Routine newborn care should be billed by the pediatrician or newborn care provider.

What diagnosis codes should be used with 99460?

Use Z00.110 (health examination for newborn under 8 days old) as the primary diagnosis, along with an appropriate Z38.x code indicating the birth status (such as Z38.00 for single liveborn infant delivered vaginally). The Z38 code should reflect where and how the infant was born.

Can 99460 be billed if the baby is transferred to NICU on date of birth?

If the baby requires intensive care and is admitted directly to NICU, use 99477 (initial day neonatal intensive care) instead of 99460. If the baby was initially normal and then later deteriorated requiring NICU transfer, the appropriate code depends on the level of care provided during the majority of the date of birth.