Sbsq nb em per day hosp
CPT 99462 is used when a pediatrician or neonatologist evaluates and manages a normal newborn baby in the hospital on the second, third, or subsequent days after birth before discharge.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Report 99462 only once per calendar day, regardless of how many times you see the infant
Impact: Prevents denials for duplicate billing; multiple visits same day are bundled into single 99462
Do not bill 99462 on the admission day (use 99460 or 99463) or discharge day (use 99461 or 99463)
Impact: Using wrong code for admission/discharge can result in $30-50 underpayment or denial
Document the specific calendar date, time of visit, weight, feeding assessment, jaundice check, and any parental counseling provided
Impact: Complete documentation prevents medical necessity denials and supports the $38.49 reimbursement
For infants remaining hospitalized 3+ days, continue billing 99462 daily until discharge (no visit limit)
Impact: Captures full reimbursement of $38.49 per day for extended stays; common in jaundice or feeding observation cases
Bill under the attending physician's NPI, not the delivering obstetrician, even if same practice
Impact: Billing under wrong provider specialty may trigger denials or reduced payment rates
When billing with circumcision (54150), append modifier 25 to 99462 and ensure separate documentation of medical decision-making
Impact: Without modifier 25, the E/M portion ($38.49) will likely be denied as bundled with the procedure
Common denials
Billing 99462 on the same day as 99460 (initial newborn admission) or 99238/99239 (discharge)
How to appeal: Submit corrected claim with appropriate code for the actual service date; include medical record showing admission date vs. subsequent date. If services truly spanned midnight, document time stamps proving separate calendar days.
Duplicate billing - two providers from same group billing 99462 same day for same infant
How to appeal: Review group billing practices; only one physician can bill per calendar day. If services were truly separate and medically necessary (rare), provide documentation explaining unusual circumstances and obtain modifier approval from payer.
Medical necessity denial when infant hospitalized beyond typical 2-3 day stay without documented complications
How to appeal: Provide detailed clinical notes documenting reason for extended stay (e.g., feeding difficulties, weight loss >10%, hyperbilirubinemia monitoring, maternal recovery issues preventing discharge). Include bilirubin levels, weight trends, and feeding logs.
Insufficient documentation - progress note lacks required elements for E/M service
How to appeal: Submit complete medical record including history, physical exam findings (vitals, weight, jaundice assessment, cardiopulmonary exam), assessment/plan, and time spent. Consider implementing template to ensure consistent documentation.
Frequently asked questions
How much does Medicare pay for CPT 99462 in 2025?
Medicare pays $38.49 for CPT 99462 in 2025 (both facility and non-facility rates are identical). The total RVU is 1.19, consisting of 0.84 work RVU, 0.3 practice expense RVU, and 0.05 malpractice RVU, multiplied by the 2025 conversion factor of 32.3465.
Can you bill 99462 more than once for the same baby?
Yes, you can bill 99462 once per calendar day for each subsequent day the newborn remains hospitalized after the admission day and before discharge. There is no limit to the number of days you can bill 99462 as long as the continued hospitalization is medically necessary and documented.
What is the difference between CPT 99462 and 99460?
CPT 99460 is for the initial admission evaluation and management of a normal newborn on the date of birth, while 99462 is for subsequent daily hospital care on days following admission. You would bill 99460 on day 1 and 99462 on days 2, 3, etc., until discharge.
Can I bill 99462 and a circumcision on the same day?
Yes, you can bill both CPT 99462 (newborn subsequent care) and 54150 or 54160 (circumcision) on the same day, but you must append modifier 25 to the 99462 code and document a separately identifiable E/M service beyond the pre- and post-procedure work included in the circumcision.
Do I need modifier 25 when billing 99462 with other procedures?
Yes, if you perform a separately identifiable evaluation and management service on the same day as a minor procedure, append modifier 25 to 99462. Common scenarios include circumcision, frenotomy, or other newborn procedures. The documentation must show the E/M was significant and separate from the procedure.
What documentation is required to bill CPT 99462?
You must document the date and time of service, interval history (feeding, elimination, behavior), physical exam with vitals and weight, jaundice assessment, overall assessment of the newborn's condition, medical decision-making for continued hospitalization, parent counseling, and discharge planning. Each daily note should stand alone as a complete E/M service.
Can a nurse practitioner bill CPT 99462 for newborn care?
Yes, qualified nurse practitioners and physician assistants with appropriate hospital privileges and pediatric competency can bill CPT 99462. Payment rates for non-physician practitioners are typically 85% of the physician fee schedule amount unless they are credentialed and billing incident-to a physician.