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CPT code 99461: Newborn care, initial, non-facility setting2026 Medicare rate & RVUs in Hawaii, Guam, HI

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 Hawaii, Guam, HI, Medicare pays $99.64 for 99461 in the office and $53.31 when it’s performed in a hospital or facility.

$99.64Office (non-facility)
$53.31Hospital or facility
+6.2%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 Hawaii, Guam, HI
  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 Hawaii, Guam, HI 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. Hawaii, Guam, HI pays $99.64. The RVUs are the same everywhere; the geographic indexes change the dollars.

99461 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$99.64
  2. Los Angeles, CA · California$103.84+$4.20
  3. Washington, DC area · District of Columbia$105.19+$5.55
  4. Miami, FL · Florida$99.46−$0.18
  5. Chicago, IL · Illinois$97.43−$2.21
  6. Manhattan, NY · New York$105.93+$6.29
  7. Alaska · Alaska$117.06+$17.42

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

Every other payment area

99461 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$86.66$51.01
ArkansasArkansas$85.75$50.75
ArizonaArizona$91.99$52.50
Bakersfield, CACalifornia$98.49$53.83
Chico, CACalifornia$98.23$53.57
El Centro, CACalifornia$98.24$53.58
Fresno, CACalifornia$98.23$53.57
Hanford, CACalifornia$98.23$53.57

99461 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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 Hawaii, Guam, HI 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

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 99461 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.26× 1.0001.2600
Practice expense1.48× 1.1371.6828
Malpractice0.07× 0.5790.0405
Total RVUs2.9833
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$99.64

Office: (1.26 × 1 + 1.48 × 1.137 + 0.07 × 0.579) × $33.4009 = $99.64

Facility: (1.26 × 1 + 0.26 × 1.137 + 0.07 × 0.579) × $33.4009 = $53.31

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.

Codes related to 99461

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 99461
CodeHow it relatesOffice range, Hawaii, Guam, HI
Used instead
99460Newborn care, initial hospital dayInitial care of a normal newborn in a hospital or birthing center.No office rate
99463Newborn care, admission and discharge same dayNewborn care when hospital or birthing-center admission and discharge occur on the same day.No office rate
Same family
99462Newborn care, subsequent hospital daySubsequent daily newborn care in a hospital or birthing center.No office rate

How 99461 has changed in Hawaii, Guam, HI

99461 · Office / nonfacility

$99.64

Effective 2026-10-01

The base rate is $5.40 higher than on 2025-10-01, moving from $94.24 to $99.64 (5.7%).

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

    $94.24changed to$99.64

    • 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
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $97.17changed to$94.24

    • 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

    $95.58changed to$97.17

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $97.74changed to$95.58

    • 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 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $99.54changed to$97.74

    • 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 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $98.37changed to$99.54

    • 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

    $98.21changed to$98.37

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.22 changed to 1.30
    • Work GPCI 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $98.44changed to$98.21

    • 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 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $97.92changed to$98.44

    • 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

    $100.50changed to$97.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.29 changed to 1.23
    • Work GPCI 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $98.61changed to$100.50

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.24 changed to 1.29
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $97.07changed to$98.61

    • 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

    $96.59changed to$97.07

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $105.61changed to$96.59

    • 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 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $107.20changed to$105.61

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.59 changed to 1.41
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$107.20

  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$99.64$53.31RVU26D
2026-07-01$99.64$53.31RVU26C
2026-04-01$99.64$53.31RVU26B
2026-01-01$99.64$53.31RVU26A
2025-10-01$94.24$59.30RVU25D
2025-07-01$94.24$59.30RVU25C
2025-04-01$94.24$59.30RVU25B
2025-01-01$94.24$59.30RVU25A
2024-10-01$97.17$61.22RVU24D
2024-07-01$97.17$61.22RVU24C
2024-04-01$97.17$61.22RVU24B
2024-03-09$97.17$61.22RVU24AR
2024-01-01$95.58$60.22RVU24A
2023-10-01$97.74$62.78RVU23D
2023-07-01$97.74$62.78RVU23C
2023-04-01$97.74$62.78RVU23B
2023-01-01$97.74$62.78RVU23A
2022-10-01$99.54$64.73RVU22D
2022-07-01$99.54$64.73RVU22C
2022-04-01$99.54$64.73RVU22B
2022-01-01$99.54$64.73RVU22A
2021-10-01$98.37$64.47RVU21D
2021-07-01$98.37$64.47RVU21C
2021-04-01$98.37$64.47RVU21B
2021-01-01$98.37$64.47RVU21A
2020-10-01$98.21$65.59RVU20D
2020-07-01$98.21$65.59RVU20C
2020-04-01$98.21$65.59RVU20B
2020-01-01$98.21$65.59RVU20A
2019-10-01$98.44$65.40RVU19D
2019-07-01$98.44$65.40RVU19C
2019-04-01$98.44$65.40RVU19B
2019-01-01$98.44$65.40RVU19A
2018-10-01$97.92$65.33RVU18D
2018-07-01$97.92$65.33RVU18C
2018-04-01$97.92$65.33RVU18B
2018-01-01$97.92$65.33RVU18AR1
2017-10-01$100.50$65.72RVU17D
2017-07-01$100.50$65.72RVU17C
2017-04-01$100.50$65.72RVU17B
2017-01-01$100.50$65.72RVU17A
2016-10-01$98.61$65.32RVU16D
2016-07-01$98.61$65.32RVU16C
2016-04-01$98.61$65.32RVU16B
2016-01-01$98.61$65.32RVU16A
2015-10-01$97.07$65.34RVU15D
2015-07-01$97.07$65.34RVU15C
2015-04-01$96.59$65.01RVU15B
2015-01-01$96.59$65.01RVU15A
2014-10-01$105.61$67.03RVU14D
2014-07-01$105.61$67.03RVU14C
2014-04-01$105.61$67.03RVU14B
2014-01-01$105.61$67.03RVU14A
2013-10-01$107.20$65.19RVU13D
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 Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Hawaii

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 Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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