CPT code 99461: Newborn care, initial, non-facility setting2026 Medicare rate & RVUs in Los Angeles, CA

Initial daily evaluation and management of a normal newborn in an office, home, or other setting outside a hospital or birthing center.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Los Angeles, CA, Medicare pays $103.84 for 99461 in the office and $55.64 when it’s performed in a hospital or facility.

$103.84Office (non-facility)
$55.64Hospital or facility
+10.6%vs the national office rate ($93.86)

Check a contract rate as a % of Medicare · 99461 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 99461 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Los Angeles, CA
  2. What 99461 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 99461 covers

This service covers the initial daily evaluation and management of a normal newborn outside a hospital or birthing center. A pediatrician, family physician, or other qualified clinician may provide it in an office, clinic, or home setting. The assessment addresses the newborn’s health and routine needs, rather than intensive stabilization or management of critical illness.

Report one service for the day when the clinician provides initial newborn care in this non-facility setting. The setting and whether this is the initial newborn-care service distinguish 99461 from hospital or birthing-center newborn care. Documentation should identify the date and location, newborn status, history and examination, clinical assessment, and management or counseling performed. The CMS physician fee schedule valuation includes physician work, practice expense, and malpractice components.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Los Angeles, CA compares for 99461

Across 109 of 109 payment localities, the office rate for 99461 runs from $85.75 in Arkansas to $119.25 in San Benito County, CA. Los Angeles, CA pays $103.84. The RVUs are the same everywhere; the geographic indexes change the dollars.

99461 in Los Angeles, CA vs other payment areas
  1. Los Angeles, CA · this page$103.84
  2. Bakersfield, CA · California$98.49−$5.35
  3. Chico, CA · California$98.23−$5.61
  4. El Centro, CA · California$98.24−$5.60
  5. Fresno, CA · California$98.23−$5.61
  6. Hanford, CA · California$98.23−$5.61
  7. Madera, CA · California$98.23−$5.61

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

99461 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$98.23$53.57
Modesto, CACalifornia$98.23$53.57
Napa, CACalifornia$111.08$57.37
Oxnard, CACalifornia$103.15$54.98
Redding, CACalifornia$98.23$53.57
Rest of CaliforniaCalifornia$98.23$53.57
Riverside, CACalifornia$99.02$54.35
Sacramento, CACalifornia$102.34$54.95

99461 rates by state

Office rate range in each state. Select a state to see its payment localities.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$85.75

$117.06

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
99461 office rate range by state
State / territoryOffice rate rangeLocalities
AK$117.061
AL$86.661
AR$85.751
AZ$91.991
CA$98.23–$119.2529
CO$97.011
CT$99.001
DC$105.191
DE$93.241
FL$92.86–$99.463
GA$88.97–$95.242
GU$99.641
HI$99.641
IA$88.241
ID$88.671
IL$90.87–$97.434
IN$89.051
KS$87.951
KY$88.171
LA$88.07–$91.262
MA$96.68–$104.912
MD$94.68–$105.193
ME$89.02–$92.552
MI$89.86–$93.732
MN$93.641
MO$86.97–$91.493
MS$86.381
MT$93.851
NC$89.701
ND$92.471
NE$88.601
NH$95.591
NJ$100.31–$104.582
NM$90.221
NV$93.521
NY$90.69–$107.905
OH$89.571
OK$88.051
OR$92.96–$99.422
PA$89.67–$97.092
PR$94.371
RI$96.031
SC$89.751
SD$92.301
TN$88.281
TX$89.24–$96.548
UT$90.651
VA$92.33–$105.192
VI$94.371
VT$92.211
WA$96.46–$106.752
WI$90.161
WV$88.391
WY$93.251

See 99461 in every payment locality

How the 99461 rate is calculated

Each of 99461’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 99461

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.26

1.26 RVUs× 1.000 GPCI

Practice expense1.48

1.48 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

2.8100

Conversion factor

$33.4009

Medicare rate

$93.86

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Los Angeles, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,128

Code
99461
Physician work
1.26
Practice expense
1.48
Malpractice
0.07

GPCI2026.csv

13

Locality
Los Angeles, CA
Physician work
1.041
Practice expense
1.183
Malpractice
0.664
Office calculation for 99461 in Los Angeles, CA
ComponentRVULocality factorAdjusted
Physician work1.26× 1.0411.3117
Practice expense1.48× 1.1831.7508
Malpractice0.07× 0.6640.0465
Total RVUs3.1090
Conversion factor× 33.4009

Office rate, Los Angeles, CA$103.84

Office: (1.26 × 1.041 + 1.48 × 1.183 + 0.07 × 0.664) × $33.4009 = $103.84

Facility: (1.26 × 1.041 + 0.26 × 1.183 + 0.07 × 0.664) × $33.4009 = $55.64

Open 99461 in the RVU calculator

Payment rules and modifiers for 99461

99461 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 99461

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$93.86

Non-facility (office)
$93.86
Facility
$53.11

Higher because the practice carries its own overhead.

How 99461 has changed in Los Angeles, CA

99461 · Office / nonfacility

$103.84

Effective 2026-10-01

The base rate is $5.52 higher than on 2025-10-01, moving from $98.32 to $103.84 (5.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $98.32changed to$103.84

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.40 changed to 1.48
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.042 changed to 1.041
    • Practice expense GPCI 1.194 changed to 1.183
    • Malpractice GPCI 0.690 changed to 0.664

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $101.41changed to$98.32

    • Conversion factor 33.2875 changed to 32.3465
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $99.76changed to$101.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $101.69changed to$99.76

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.36 changed to 1.40
    • Malpractice RVU 0.10 changed to 0.09
    • Work GPCI 1.045 changed to 1.042
    • Practice expense GPCI 1.185 changed to 1.194
    • Malpractice GPCI 0.724 changed to 0.690
  5. January 1, 2023

    RVU23A

    $102.95changed to$101.69

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.35 changed to 1.36
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.048 changed to 1.045
    • Practice expense GPCI 1.175 changed to 1.185
    • Malpractice GPCI 0.757 changed to 0.724

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $101.75changed to$102.95

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.30 changed to 1.35

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $101.74changed to$101.75

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.22 changed to 1.30
    • Work GPCI 1.047 changed to 1.048
    • Practice expense GPCI 1.176 changed to 1.175
    • Malpractice GPCI 0.725 changed to 0.757

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $102.10changed to$101.74

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.24 changed to 1.22
    • Malpractice RVU 0.08 changed to 0.09
    • Work GPCI 1.046 changed to 1.047
    • Practice expense GPCI 1.177 changed to 1.176
    • Malpractice GPCI 0.694 changed to 0.725

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $101.56changed to$102.10

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.23 changed to 1.24

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $103.77changed to$101.56

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.29 changed to 1.23
    • Work GPCI 1.047 changed to 1.046
    • Practice expense GPCI 1.169 changed to 1.177
    • Malpractice GPCI 0.801 changed to 0.694

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $101.38changed to$103.77

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.24 changed to 1.29
    • Practice expense GPCI 1.161 changed to 1.169
    • Malpractice GPCI 0.908 changed to 0.801

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $99.75changed to$101.38

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.20 changed to 1.24
    • Malpractice RVU 0.07 changed to 0.08

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $99.25changed to$99.75

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $107.74changed to$99.25

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.41 changed to 1.20
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.042 changed to 1.047
    • Practice expense GPCI 1.158 changed to 1.161
    • Malpractice GPCI 0.775 changed to 0.908

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $108.59changed to$107.74

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.59 changed to 1.41
    • Work GPCI 1.036 changed to 1.042
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.642 changed to 0.775

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$108.59

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$103.84$55.64RVU26D
2026-07-01$103.84$55.64RVU26C
2026-04-01$103.84$55.64RVU26B
2026-01-01$103.84$55.64RVU26A
2025-10-01$98.32$62.02RVU25D
2025-07-01$98.32$62.02RVU25C
2025-04-01$98.32$62.02RVU25B
2025-01-01$98.32$62.02RVU25A
2024-10-01$101.41$64.05RVU24D
2024-07-01$101.41$64.05RVU24C
2024-04-01$101.41$64.05RVU24B
2024-03-09$101.41$64.05RVU24AR
2024-01-01$99.76$63.01RVU24A
2023-10-01$101.69$65.54RVU23D
2023-07-01$101.69$65.54RVU23C
2023-04-01$101.69$65.54RVU23B
2023-01-01$101.69$65.54RVU23A
2022-10-01$102.95$67.17RVU22D
2022-07-01$102.95$67.17RVU22C
2022-04-01$102.95$67.17RVU22B
2022-01-01$102.95$67.17RVU22A
2021-10-01$101.75$66.90RVU21D
2021-07-01$101.75$66.90RVU21C
2021-04-01$101.75$66.90RVU21B
2021-01-01$101.75$66.90RVU21A
2020-10-01$101.74$68.21RVU20D
2020-07-01$101.74$68.21RVU20C
2020-04-01$101.74$68.21RVU20B
2020-01-01$101.74$68.21RVU20A
2019-10-01$102.10$68.16RVU19D
2019-07-01$102.10$68.16RVU19C
2019-04-01$102.10$68.16RVU19B
2019-01-01$102.10$68.16RVU19A
2018-10-01$101.56$68.09RVU18D
2018-07-01$101.56$68.09RVU18C
2018-04-01$101.56$68.09RVU18B
2018-01-01$101.56$68.09RVU18AR1
2017-10-01$103.77$68.52RVU17D
2017-07-01$103.77$68.52RVU17C
2017-04-01$103.77$68.52RVU17B
2017-01-01$103.77$68.52RVU17A
2016-10-01$101.38$68.12RVU16D
2016-07-01$101.38$68.12RVU16C
2016-04-01$101.38$68.12RVU16B
2016-01-01$101.38$68.12RVU16A
2015-10-01$99.75$68.04RVU15D
2015-07-01$99.75$68.04RVU15C
2015-04-01$99.25$67.71RVU15B
2015-01-01$99.25$67.71RVU15A
2014-10-01$107.74$69.17RVU14D
2014-07-01$107.74$69.17RVU14C
2014-04-01$107.74$69.17RVU14B
2014-01-01$107.74$69.17RVU14A
2013-10-01$108.59$66.58RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 99461 for an earlier date of service

Where the Los Angeles, CA rate applies

Los Angeles, CA is a Medicare payment area, not a city. Our Census mapping connects it to 189 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Anaheim
  • Long Beach
  • Los Angeles
  • Orange
  • Acton
  • Agoura Hills
  • Agua Dulce
  • Alhambra

Browse all communities in California

99461 billing questions

How does 99461 differ from 99460?

Both describe initial care of a normal newborn, but 99461 is for care outside a hospital or birthing center. Use 99460 for the corresponding initial care in a hospital or birthing center.

Is 99461 appropriate for the newborn’s first office visit after discharge?

Not solely because it is the first office encounter. The code describes initial newborn care in a non-facility setting; choose based on the care provided and whether initial newborn care has already occurred.

Is 99461 reported by time or units?

It is a per-day service, not a time-based code. The documentation should support the initial newborn evaluation and management provided that day.

What documentation supports 99461?

Record the date and non-facility location, the newborn’s status, the relevant history and examination, the assessment, and the management or counseling provided.

Can 99461 be used when the newborn needs critical care?

99461 describes initial care of a normal newborn. When the newborn’s condition requires critical care, select the code that represents the critical-care service provided.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 99461PPRRVU2026_Oct_nonQPP.csv, line 13,128 (RVU26D)
Geographic factors for Los Angeles, CAGPCI2026.csv, line 13 (RVU26D)

Open CMS sourceHow we calculate rates

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