CPT 99464E&M

Attendance at delivery

CPT 99464 covers the physician's attendance at a newborn's delivery when requested by the delivering physician, to provide initial stabilization or evaluation even when full resuscitation is not required.

Showing rates for

National Average

Base Medicare rate

$69.22

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

1.5

PE RVU (NF)

0.54

MP RVU

0.1

Total RVU

2.14

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

NCCI bundling edits

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Billing tips

Document the specific request from the delivering physician including the reason for requesting attendance (maternal risk factors, fetal concerns, anticipated complications)
Impact: Prevents 30-40% of denials based on medical necessity; required element for Medicare and most commercial payers
Clearly differentiate between 99464 (attendance/stabilization) and 99465 (resuscitation with positive pressure ventilation); if positive pressure ventilation or chest compressions are performed, bill 99465 instead
Impact: 99465 reimburses at approximately $166 vs $69.22 for 99464, representing a $96.78 difference when appropriate
Bill separately for each infant in multiple births (twins, triplets) using modifier 76 or appropriate units, as each infant receives individual evaluation
Impact: Increases reimbursement proportionally; two infants = $138.44 vs $69.22 for single delivery attendance
Ensure time of attendance and duration are documented, particularly if physician waited for delivery but infant was born during the attendance period
Impact: Supports medical necessity and differentiates from prolonged services; reduces audit risk by 25-35%
Do not bill 99464 if the physician is the delivering physician or performing concurrent C-section; this code is for requested standby attendance only
Impact: Prevents unbundling denials and potential fraud flags; delivering physician services are included in global OB codes
Verify payer-specific policies on global newborn care periods; some payers bundle 99464 into subsequent hospital care if same physician continues care

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Frequently asked questions

What is CPT code 99464 used for?

CPT 99464 is used for physician attendance at delivery when requested by the delivering physician to provide initial stabilization of a newborn. It covers the physician's presence, immediate assessment, and minor stabilization procedures that do not include positive pressure ventilation or comprehensive resuscitation.

How much does Medicare pay for CPT 99464 in 2025?

Medicare pays $69.22 for CPT 99464 in 2025 based on the national average rate. This applies to both facility and non-facility settings, with a total RVU value of 2.14 (Work RVU 1.5, PE RVU 0.54, MP RVU 0.1).

What is the difference between CPT 99464 and 99465?

CPT 99464 is for attendance at delivery with initial stabilization only, while 99465 is for delivery attendance requiring resuscitation with positive pressure ventilation and/or chest compressions. If any positive pressure ventilation is provided, bill 99465 instead of 99464.

Can you bill 99464 for twins or multiple births?

Yes, CPT 99464 can be billed for each infant in a multiple birth delivery. Use modifier 76 for the second and subsequent infants when the same physician attends all deliveries, as each newborn receives individual evaluation and stabilization.

Do you need a request to bill CPT 99464?

Yes, documentation must show the delivering physician requested the attendance at delivery. This is a key requirement for medical necessity and reimbursement. The request should be documented in the prenatal record, delivery notes, or consultation request.

Can the delivering physician bill CPT 99464?

No, the delivering physician cannot bill CPT 99464 as this service is considered included in the global obstetric delivery codes. Only a separately requested physician (typically pediatrician or neonatologist) who attends the delivery for newborn evaluation can bill this code.

What documentation is required for CPT 99464?

Required documentation includes: the delivering physician's request for attendance, maternal/fetal risk factors justifying the attendance, time of delivery and physician presence, initial newborn assessment with Apgar scores, any stabilization procedures performed, and confirmation that services are distinct from subsequent newborn care.