Attendance at delivery
CPT 99464 covers a physician's attendance at a newborn's delivery when requested by the delivering physician, typically when complications are anticipated or the baby may need immediate resuscitation or specialized care.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document the specific request from the delivering physician and the medical indication for attendance, including maternal or fetal risk factors identified before delivery
Impact: Prevents up to 40% of denials for lack of medical necessity; creates audit-proof record of the request
Record exact time of arrival in L&D, time of delivery, and duration of attendance separately from any subsequent services like admission or critical care
Impact: Enables billing of separate services with modifier 25 when appropriate, potentially adding $200-400 in additional reimbursement for critical care or admission services
Bill 99464 only once per delivery date, even if prolonged; use modifier 22 with extended documentation rather than attempting to bill multiple units
Impact: Avoids automatic denials for duplicate billing while preserving opportunity for increased payment through modifier 22
For multiple gestations (twins, triplets), verify payer policy on whether to bill per delivery or per infant; some payers allow 99464 for each separately delivered infant
Impact: Could result in legitimate additional $69.22 per additional infant when payer policy permits
Do not bill 99464 on the same date as routine newborn admission (99460-99463) unless services are clearly distinct and separately documented with modifier 25
Impact: Prevents bundling denials that reject both claims; proper documentation can preserve both payments totaling $138-270
Ensure delivery attendance is documented in both the maternal delivery record and the newborn's medical record with physician signature and timestamp
Impact: Satisfies medical record documentation requirements during audits and reduces risk of recoupment of the $69.22 payment
Common denials
Medical necessity not established - payer states no high-risk factors documented to justify physician attendance
How to appeal: Submit appeal with labor and delivery records showing documented risk factors (preterm labor, fetal distress tracings, maternal complications), delivering physician's consultation note requesting attendance, and specialty society guidelines supporting attendance for the specific risk factors
Bundled with newborn admission service (99460-99463) as considered part of comprehensive newborn care
How to appeal: Provide documentation showing attendance was at specific request of delivering physician prior to delivery, occurred before decision to admit was made, and address separate distinct conditions (delivery stabilization vs. ongoing newborn care). Include timestamps showing temporal separation of services
Duplicate billing when multiple providers from same group attend same delivery
How to appeal: Submit documentation clarifying each provider's distinct role, different times of service, or show they attended different deliveries (multiple gestations). Include group policy on call coverage and medical necessity for multiple attendees
Insufficient documentation - no physician signature, time not recorded, or request for attendance not documented
How to appeal: Provide complete medical record including signed and timed physician note, delivering physician's request (consultation note, call log, or delivery record notation), and attestation statement if signature was delayed. Submit late signature policy if applicable
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99464 in 2025?
Medicare pays $69.22 for CPT 99464 in 2025 (both facility and non-facility rates are the same). The code has 2.14 total RVUs (1.5 work RVU, 0.54 practice expense RVU, 0.1 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
Can CPT 99464 be billed with a newborn admission code on the same day?
Yes, but only with modifier 25 and when services are clearly distinct and separately documented. The attendance at delivery (99464) must be documented as occurring at the specific request of the delivering physician before or during delivery, while the admission service (99460-99463) represents separate comprehensive evaluation after stabilization. Both must be supported by separate documentation with different times of service.
Who can bill CPT code 99464 for attendance at delivery?
Physicians (MD or DO) with appropriate credentials and hospital privileges, typically neonatologists, pediatricians, or family physicians with newborn care privileges. Some payers allow qualified nurse practitioners or physician assistants to bill this code (often with modifier AS at 85% reimbursement), but requirements vary by state and payer. The provider must be physically present at delivery and qualified to perform neonatal resuscitation.
What documentation is required to support billing CPT 99464?
Required documentation includes: the delivering physician's specific request for attendance with documented risk factors, provider's time of arrival and delivery time, physical presence at delivery, initial newborn assessment with APGAR scores, any resuscitation procedures performed, newborn's condition and plan, and a signed, timed note. The documentation must establish medical necessity based on anticipated high-risk factors identified before delivery.
Can you bill 99464 twice for twin deliveries?
Payer policies vary significantly. Some payers allow separate billing for each infant if delivered at distinctly different times requiring separate attendance and stabilization (bill second service with modifier 76). Others reimburse only one attendance per delivery date regardless of number of infants. Medicare typically pays once per delivery date. Always verify specific payer policy before billing multiple units.
What are common reasons for CPT 99464 claim denials?
The most common denials include: lack of documented medical necessity (no high-risk factors documented), bundling with newborn admission codes (99460-99463), insufficient documentation of physician presence at actual delivery time, missing documentation of the delivering physician's request for attendance, and duplicate billing when multiple providers attend the same delivery.
What qualifies as medical necessity for billing attendance at delivery?
Medical necessity requires documented maternal or fetal risk factors that justify specialized physician attendance, such as: prematurity (less than 37 weeks), fetal distress or abnormal heart tracings, meconium-stained fluid, multiple gestation, known fetal anomalies, maternal conditions affecting the fetus (diabetes, preeclampsia, substance abuse), malpresentation, or anticipated need for immediate resuscitation. The risk factors must be documented before delivery and the delivering physician must request the attendance.