Nb resuscitation
CPT 99465 covers the attendance and initial stabilization of a newborn who requires resuscitation at birth. This code is used when a physician provides positive-pressure ventilation and/or chest compressions to a newborn immediately after delivery.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document the precise resuscitation interventions performed (positive-pressure ventilation, chest compressions, medications administered) with start and stop times
Impact: Clear documentation of specific interventions prevents denials and supports the $135.53 reimbursement versus denial risk of 100% loss
Bill 99465 separately from delivery codes (59400, 59510, 59514, 59515) as this represents a distinct resuscitation service, not routine newborn care
Impact: Ensures full reimbursement for both services; failure to bill separately results in loss of $135.53
Verify that documentation confirms positive-pressure ventilation and/or chest compressions were performed, not just oxygen administration or routine suctioning
Impact: Medicare and commercial payers deny claims lacking evidence of active resuscitation, resulting in 100% claim denial
Bill under the resuscitating physician's NPI, not the delivering obstetrician, unless the OB performed the actual resuscitation
Impact: Correct provider attribution ensures clean claims processing and prevents coordination of benefits issues
Do not bill 99465 in conjunction with 99464 (initial newborn care) on the same date by the same provider for the same infant
Impact: These codes are mutually exclusive; incorrect billing triggers denials and potential audit flags
Append appropriate modifiers when multiple physicians participate in resuscitation to ensure each provider receives appropriate compensation
Impact: Modifier 62 ensures each co-surgeon receives $84.71 rather than risk of denial for duplicate billing
Common denials
Insufficient documentation of active resuscitation interventions (positive-pressure ventilation/chest compressions not clearly documented)
How to appeal: Submit detailed delivery room record showing specific resuscitation steps, Apgar scores, time stamps, and equipment used (bag-mask, T-piece resuscitator). Include neonatal resuscitation flow sheet if available.
Bundling denial - payer considers resuscitation included in delivery or initial newborn care services
How to appeal: Cite CPT guidelines stating 99465 is separately reportable from delivery services. Provide documentation showing resuscitation was performed by different physician than delivering provider, or clearly distinct from routine newborn stabilization.
Medical necessity denial - payer questions whether resuscitation level interventions were truly required
How to appeal: Submit complete delivery records including indication for resuscitation (Apgar scores, heart rate, respiratory effort), maternal/fetal risk factors, and neonatal outcome data demonstrating medical necessity for emergent intervention.
Duplicate billing when multiple providers submit claims for same resuscitation event without proper modifiers
How to appeal: Resubmit with appropriate modifier (62, 66, or AS) and detailed explanation of each provider's distinct role in the resuscitation. Include time-stamped documentation showing simultaneous participation by multiple physicians.
Frequently asked questions
What is the difference between CPT 99464 and 99465?
CPT 99464 is for routine attendance at delivery and initial stabilization of a normal newborn, while 99465 is specifically for newborns requiring active resuscitation including positive-pressure ventilation and/or chest compressions. Only one code can be billed per infant per date of service.
How much does Medicare pay for CPT 99465 in 2025?
The 2025 Medicare national average payment rate for CPT 99465 is $135.53 for both facility and non-facility settings, based on 4.19 total RVUs and a conversion factor of 32.3465.
Can an obstetrician bill CPT 99465 for newborn resuscitation?
Yes, if the obstetrician actually performs the resuscitation with positive-pressure ventilation and/or chest compressions and documents this thoroughly. However, resuscitation is typically performed by a pediatrician, neonatologist, or family physician, and only the physician performing the resuscitation should bill.
What documentation is required to bill CPT 99465?
Documentation must include Apgar scores, specific resuscitation interventions performed (type of ventilation, chest compressions), time stamps, equipment used, indications for resuscitation, personnel present, and newborn response to interventions. Generic statements like 'resuscitation performed' are insufficient.
Can CPT 99465 be billed with a delivery code on the same day?
Yes, 99465 is separately reportable from maternal delivery codes (59400, 59510, 59514, 59515) when performed by the same or different physician. The resuscitation represents a distinct service to the newborn, not the mother.
What RVU value does CPT 99465 have?
CPT 99465 has a total RVU of 4.19, consisting of 2.93 work RVU, 1.06 practice expense RVU (both facility and non-facility), and 0.2 malpractice RVU for 2025.
When should modifier 62 be used with CPT 99465?
Modifier 62 should be appended when two physicians work together as co-surgeons during the resuscitation, each performing distinct critical portions (e.g., one managing airway/ventilation while another performs cardiac compressions and vascular access). Each physician then receives 62.5% of the allowed amount.