CPT 99462E&M

Sbsq nb em per day hosp

CPT 99462 is used when a doctor evaluates and manages a healthy newborn baby in the hospital on days after the initial birth day. This covers daily check-ins to ensure the baby is feeding well, maintaining body temperature, and developing normally before going home.

Showing rates for

National Average

Base Medicare rate

$38.49

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

0.84

PE RVU (NF)

0.3

MP RVU

0.05

Total RVU

1.19

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

NCCI bundling edits

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Billing tips

Bill 99462 once per calendar day, not per 24-hour period from birth - timing resets at midnight
Impact: Prevents denials for duplicate billing; ensures maximum reimbursement of $38.49 per eligible day
Use 99462 only after the initial day of care (99460/99461 for day of birth); transition at midnight regardless of birth time
Impact: Incorrect sequencing causes denials; day 1 codes pay $182-$266 vs $38.49 for 99462, so proper initial coding is critical
Document time of service and all required elements (interval history, exam, assessment, plan, parent education) to support medical necessity
Impact: Missing documentation is the #1 denial reason; complete records reduce audit risk and support the full $38.49 payment
Verify newborn does not meet criteria for 99477-99480 (intensive/critical care) before using 99462
Impact: Intensive care codes pay $185-$405 per day; undercoding costs significant revenue, while overcoding risks fraud allegations
When billing with same-day procedures (circumcision, frenotomy), append modifier 25 to 99462 and document the E/M was separately identifiable
Impact: Without modifier 25, the $38.49 E/M is typically bundled and denied; proper modifier use captures full payment for both services
For split/shared visits with NPPs in facility settings, ensure documentation meets Medicare's substantive portion requirements (2023+ rules)
Impact: Improper split/shared billing can result in downcoding or complete denial of the $38.49 payment plus potential compliance issues

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Frequently asked questions

What is the difference between CPT 99462 and 99460?

CPT 99460 is for the initial hospital care on the date of birth or admission, while 99462 is for each subsequent day of care after the first day. 99460 reimburses at a higher rate and includes the comprehensive birth admission assessment, whereas 99462 covers daily follow-up visits.

How much does Medicare pay for CPT 99462 in 2025?

Medicare pays $38.49 for CPT 99462 in 2025 based on the national average rate. This is calculated from 1.19 total RVUs (0.84 work + 0.3 PE + 0.05 MP) multiplied by the 2025 conversion factor of 32.3465.

Can you bill 99462 more than once per day?

Generally no. CPT 99462 is intended to be billed once per calendar day per newborn. If multiple visits occur on the same day due to unusual circumstances, modifier 76 may be appended to the second visit, but this requires exceptional documentation of medical necessity and is subject to payer review.

When should I use 99462 versus 99477 for newborn care?

Use 99462 for normal, healthy newborns in routine nursery care. Use 99477 for newborns requiring intensive care services with critical illness or instability. If the infant needs continuous monitoring, respiratory support beyond room air, IV medications, or other intensive interventions, 99477-99480 codes are appropriate instead of 99462.

Can a nurse practitioner bill CPT 99462?

Yes, qualified Nurse Practitioners and Physician Assistants can bill 99462 when they independently perform the subsequent newborn care, subject to state scope of practice laws and hospital privileges. Medicare reimburses NPPs at 85% of the physician rate unless billing incident-to or in a split/shared arrangement.

How many days can you bill 99462 for the same newborn?

You can bill 99462 for each day the newborn remains hospitalized after the initial day, typically 1-3 additional days for normal deliveries. There is no specific limit, but extended stays beyond typical 2-4 day newborn admissions may trigger medical necessity review to ensure the patient doesn't require intensive care coding or that continued hospitalization is justified.

Do I need modifier 25 when billing 99462 with circumcision?

Yes, append modifier 25 to 99462 when performing a circumcision (54150 or 54160) on the same day. The modifier indicates the E/M service was separately identifiable from the procedure. Documentation must clearly show the routine daily newborn assessment was distinct from the pre-procedure evaluation for circumcision.