CPT code 99461: Newborn care, initial, non-facility setting2026 Medicare rate & RVUs in Metropolitan Boston, MA
Initial daily evaluation and management of a normal newborn in an office, home, or other setting outside a hospital or birthing center.
In Metropolitan Boston, MA, Medicare pays $104.91 for 99461 in the office and $56.26 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Metropolitan Boston, MA 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. Metropolitan Boston, MA pays $104.91. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Metropolitan Boston, MA · this page$104.91
- Rest of Massachusetts · Massachusetts$96.68−$8.23
- Los Angeles, CA · California$103.84−$1.07
- Washington, DC area · District of Columbia$105.19+$0.28
- Miami, FL · Florida$99.46−$5.45
- Chicago, IL · Illinois$97.43−$7.48
- Manhattan, NY · New York$105.93+$1.02
Other areas in Massachusetts first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlaskaAlaska | $117.06 | $73.66 |
| 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 |
| Madera, CACalifornia | $98.23 | $53.57 |
| 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 |
| Salinas, CACalifornia | $101.94 | $54.71 |
| San Diego, CACalifornia | $103.74 | $55.00 |
| Marin County, CACalifornia | $116.86 | $59.40 |
| San Francisco, CACalifornia | $116.78 | $59.32 |
| San Benito County, CACalifornia | $119.25 | $60.49 |
| Santa Clara County, CACalifornia | $118.93 | $60.17 |
| San Luis Obispo, CACalifornia | $100.36 | $53.95 |
| Santa Cruz, CACalifornia | $104.28 | $54.77 |
| Santa Maria, CACalifornia | $102.16 | $54.64 |
| Santa Rosa, CACalifornia | $105.31 | $55.27 |
| Stockton, CACalifornia | $98.23 | $53.57 |
| Vallejo, CACalifornia | $110.96 | $57.26 |
| Visalia, CACalifornia | $98.23 | $53.57 |
| Yuba City, CACalifornia | $98.23 | $53.57 |
| ColoradoColorado | $97.01 | $53.66 |
| ConnecticutConnecticut | $99.00 | $55.11 |
| DelawareDelaware | $93.24 | $52.98 |
| Fort Lauderdale, FLFlorida | $96.39 | $55.11 |
| Rest of FloridaFlorida | $92.86 | $53.90 |
| Atlanta, GAGeorgia | $95.24 | $53.84 |
| Rest of GeorgiaGeorgia | $88.97 | $52.62 |
| Hawaii, Guam, HIHawaii | $99.64 | $53.31 |
| IowaIowa | $88.24 | $50.96 |
| IdahoIdaho | $88.67 | $51.18 |
| East St. Louis, ILIllinois | $92.27 | $54.78 |
| Rest of IllinoisIllinois | $90.87 | $53.67 |
| Suburban Chicago, ILIllinois | $97.29 | $55.44 |
| IndianaIndiana | $89.05 | $51.27 |
| KansasKansas | $87.95 | $51.11 |
| KentuckyKentucky | $88.17 | $51.94 |
| New Orleans, LALouisiana | $91.26 | $52.91 |
| Rest of LouisianaLouisiana | $88.07 | $52.01 |
| Baltimore area, MDMaryland | $98.69 | $54.97 |
| Rest of MarylandMaryland | $94.68 | $53.44 |
| Rest of MaineMaine | $89.02 | $51.53 |
| Southern Maine, MEMaine | $92.55 | $52.17 |
| Detroit, MIMichigan | $93.73 | $54.41 |
| Rest of MichiganMichigan | $89.86 | $52.65 |
| MinnesotaMinnesota | $93.64 | $51.71 |
| Metropolitan Kansas City, MOMissouri | $90.79 | $52.52 |
| Metropolitan St. Louis, MOMissouri | $91.49 | $52.70 |
| Rest of MissouriMissouri | $86.97 | $51.85 |
| MississippiMississippi | $86.38 | $51.29 |
| MontanaMontana | $93.85 | $53.10 |
| North CarolinaNorth Carolina | $89.70 | $51.68 |
| North DakotaNorth Dakota | $92.47 | $51.72 |
| NebraskaNebraska | $88.60 | $50.98 |
| New HampshireNew Hampshire | $95.59 | $53.17 |
| Northern New JerseyNew Jersey | $104.58 | $57.31 |
| Rest of New JerseyNew Jersey | $100.31 | $55.82 |
| New MexicoNew Mexico | $90.22 | $52.86 |
| NevadaNevada | $93.52 | $52.73 |
| NYC suburbs and Long Island, NYNew York | $107.90 | $59.45 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $100.94 | $56.32 |
| Queens, NYNew York | $106.58 | $58.41 |
| Rest of New YorkNew York | $90.69 | $51.98 |
| OhioOhio | $89.57 | $52.37 |
| OklahomaOklahoma | $88.05 | $51.66 |
| Portland, OROregon | $99.42 | $54.15 |
| Rest of OregonOregon | $92.96 | $52.38 |
| Metropolitan Philadelphia, PAPennsylvania | $97.09 | $54.67 |
| Rest of PennsylvaniaPennsylvania | $89.67 | $52.27 |
| Puerto RicoPuerto Rico | $94.37 | $53.17 |
| Rhode IslandRhode Island | $96.03 | $53.94 |
| South CarolinaSouth Carolina | $89.75 | $52.10 |
| South DakotaSouth Dakota | $92.30 | $51.55 |
| TennesseeTennessee | $88.28 | $51.23 |
| Austin, TXTexas | $96.54 | $53.43 |
| Beaumont, TXTexas | $89.24 | $52.16 |
| Brazoria, TXTexas | $93.23 | $52.85 |
| Dallas, TXTexas | $93.71 | $53.12 |
| Fort Worth, TXTexas | $93.24 | $53.06 |
| Galveston, TXTexas | $93.45 | $52.98 |
| Houston, TXTexas | $94.73 | $54.26 |
| Rest of TexasTexas | $91.11 | $52.44 |
| UtahUtah | $90.65 | $52.35 |
| VirginiaVirginia | $92.33 | $52.27 |
| Virgin Islands, VIUnited States Virgin Islands | $94.37 | $53.17 |
| VermontVermont | $92.21 | $51.87 |
| Rest of WashingtonWashington | $96.46 | $53.56 |
| King County, WAWashington | $106.75 | $56.76 |
| WisconsinWisconsin | $90.16 | $51.12 |
| West VirginiaWest Virginia | $88.39 | $52.98 |
| WyomingWyoming | $93.25 | $52.50 |
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $117.06 | 1 |
| AL | $86.66 | 1 |
| AR | $85.75 | 1 |
| AZ | $91.99 | 1 |
| CA | $98.23–$119.25 | 29 |
| CO | $97.01 | 1 |
| CT | $99.00 | 1 |
| DC | $105.19 | 1 |
| DE | $93.24 | 1 |
| FL | $92.86–$99.46 | 3 |
| GA | $88.97–$95.24 | 2 |
| GU | $99.64 | 1 |
| HI | $99.64 | 1 |
| IA | $88.24 | 1 |
| ID | $88.67 | 1 |
| IL | $90.87–$97.43 | 4 |
| IN | $89.05 | 1 |
| KS | $87.95 | 1 |
| KY | $88.17 | 1 |
| LA | $88.07–$91.26 | 2 |
| MA | $96.68–$104.91 | 2 |
| MD | $94.68–$105.19 | 3 |
| ME | $89.02–$92.55 | 2 |
| MI | $89.86–$93.73 | 2 |
| MN | $93.64 | 1 |
| MO | $86.97–$91.49 | 3 |
| MS | $86.38 | 1 |
| MT | $93.85 | 1 |
| NC | $89.70 | 1 |
| ND | $92.47 | 1 |
| NE | $88.60 | 1 |
| NH | $95.59 | 1 |
| NJ | $100.31–$104.58 | 2 |
| NM | $90.22 | 1 |
| NV | $93.52 | 1 |
| NY | $90.69–$107.90 | 5 |
| OH | $89.57 | 1 |
| OK | $88.05 | 1 |
| OR | $92.96–$99.42 | 2 |
| PA | $89.67–$97.09 | 2 |
| PR | $94.37 | 1 |
| RI | $96.03 | 1 |
| SC | $89.75 | 1 |
| SD | $92.30 | 1 |
| TN | $88.28 | 1 |
| TX | $89.24–$96.54 | 8 |
| UT | $90.65 | 1 |
| VA | $92.33–$105.19 | 2 |
| VI | $94.37 | 1 |
| VT | $92.21 | 1 |
| WA | $96.46–$106.75 | 2 |
| WI | $90.16 | 1 |
| WV | $88.39 | 1 |
| WY | $93.25 | 1 |
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
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 Metropolitan Boston, MA 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
62
- Locality
- Metropolitan Boston, MA
- Physician work
- 1.041
- Practice expense
- 1.194
- Malpractice
- 0.890
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.26 | × 1.041 | 1.3117 |
| Practice expense | 1.48 | × 1.194 | 1.7671 |
| Malpractice | 0.07 | × 0.890 | 0.0623 |
| Total RVUs | 3.1411 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Metropolitan Boston, MA$104.91
Office: (1.26 × 1.041 + 1.48 × 1.194 + 0.07 × 0.89) × $33.4009 = $104.91
Facility: (1.26 × 1.041 + 0.26 × 1.194 + 0.07 × 0.89) × $33.4009 = $56.26
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 Metropolitan Boston, MA
99461 · Office / nonfacility
$104.91
Effective 2026-10-01
The base rate is $5.92 higher than on 2025-10-01, moving from $98.99 to $104.91 (6.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$98.99changed to$104.91
- 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 1.197 changed to 1.194
- Malpractice GPCI 0.894 changed to 0.890
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$102.17changed to$98.99
- Conversion factor 33.2875 changed to 32.3465
- Malpractice RVU 0.09 changed to 0.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$100.50changed to$102.17
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$102.86changed to$100.50
- 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 1.200 changed to 1.197
- Malpractice GPCI 0.868 changed to 0.894
January 1, 2023
RVU23A
$104.57changed to$102.86
- 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 1.049 changed to 1.045
- Practice expense GPCI 1.203 changed to 1.200
- Malpractice GPCI 0.842 changed to 0.868
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$103.33changed to$104.57
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.30 changed to 1.35
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$102.87changed to$103.33
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.22 changed to 1.30
- Work GPCI 1.041 changed to 1.049
- Practice expense GPCI 1.191 changed to 1.203
- Malpractice GPCI 0.952 changed to 0.842
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$102.65changed to$102.87
- 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 1.033 changed to 1.041
- Practice expense GPCI 1.179 changed to 1.191
- Malpractice GPCI 1.061 changed to 0.952
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$102.12changed to$102.65
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.23 changed to 1.24
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$102.97changed to$102.12
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.29 changed to 1.23
- Work GPCI 1.025 changed to 1.033
- Practice expense GPCI 1.171 changed to 1.179
- Malpractice GPCI 0.839 changed to 1.061
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$99.28changed to$102.97
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.24 changed to 1.29
- Work GPCI 1.017 changed to 1.025
- Practice expense GPCI 1.163 changed to 1.171
- Malpractice GPCI 0.617 changed to 0.839
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$97.75changed to$99.28
- 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.
July 1, 2015
RVU15C
$97.26changed to$97.75
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$106.27changed to$97.26
- 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 1.016 changed to 1.017
- Practice expense GPCI 1.156 changed to 1.163
- Malpractice GPCI 0.704 changed to 0.617
Held through RVU15B.
January 1, 2014
RVU14A
No ratechanged to$106.27
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $104.91 | $56.26 | RVU26D |
| 2026-07-01 | $104.91 | $56.26 | RVU26C |
| 2026-04-01 | $104.91 | $56.26 | RVU26B |
| 2026-01-01 | $104.91 | $56.26 | RVU26A |
| 2025-10-01 | $98.99 | $62.59 | RVU25D |
| 2025-07-01 | $98.99 | $62.59 | RVU25C |
| 2025-04-01 | $98.99 | $62.59 | RVU25B |
| 2025-01-01 | $98.99 | $62.59 | RVU25A |
| 2024-10-01 | $102.17 | $64.71 | RVU24D |
| 2024-07-01 | $102.17 | $64.71 | RVU24C |
| 2024-04-01 | $102.17 | $64.71 | RVU24B |
| 2024-03-09 | $102.17 | $64.71 | RVU24AR |
| 2024-01-01 | $100.50 | $63.65 | RVU24A |
| 2023-10-01 | $102.86 | $66.27 | RVU23D |
| 2023-07-01 | $102.86 | $66.27 | RVU23C |
| 2023-04-01 | $102.86 | $66.27 | RVU23B |
| 2023-01-01 | $102.86 | $66.27 | RVU23A |
| 2022-10-01 | $104.57 | $67.93 | RVU22D |
| 2022-07-01 | $104.57 | $67.93 | RVU22C |
| 2022-04-01 | $104.57 | $67.93 | RVU22B |
| 2022-01-01 | $104.57 | $67.93 | RVU22A |
| 2021-10-01 | $103.33 | $67.65 | RVU21D |
| 2021-07-01 | $103.33 | $67.65 | RVU21C |
| 2021-04-01 | $103.33 | $67.65 | RVU21B |
| 2021-01-01 | $103.33 | $67.65 | RVU21A |
| 2020-10-01 | $102.87 | $68.91 | RVU20D |
| 2020-07-01 | $102.87 | $68.91 | RVU20C |
| 2020-04-01 | $102.87 | $68.91 | RVU20B |
| 2020-01-01 | $102.87 | $68.91 | RVU20A |
| 2019-10-01 | $102.65 | $68.66 | RVU19D |
| 2019-07-01 | $102.65 | $68.66 | RVU19C |
| 2019-04-01 | $102.65 | $68.66 | RVU19B |
| 2019-01-01 | $102.65 | $68.66 | RVU19A |
| 2018-10-01 | $102.12 | $68.59 | RVU18D |
| 2018-07-01 | $102.12 | $68.59 | RVU18C |
| 2018-04-01 | $102.12 | $68.59 | RVU18B |
| 2018-01-01 | $102.12 | $68.59 | RVU18AR1 |
| 2017-10-01 | $102.97 | $67.67 | RVU17D |
| 2017-07-01 | $102.97 | $67.67 | RVU17C |
| 2017-04-01 | $102.97 | $67.67 | RVU17B |
| 2017-01-01 | $102.97 | $67.67 | RVU17A |
| 2016-10-01 | $99.28 | $65.97 | RVU16D |
| 2016-07-01 | $99.28 | $65.97 | RVU16C |
| 2016-04-01 | $99.28 | $65.97 | RVU16B |
| 2016-01-01 | $99.28 | $65.97 | RVU16A |
| 2015-10-01 | $97.75 | $65.99 | RVU15D |
| 2015-07-01 | $97.75 | $65.99 | RVU15C |
| 2015-04-01 | $97.26 | $65.66 | RVU15B |
| 2015-01-01 | $97.26 | $65.66 | RVU15A |
| 2014-10-01 | $106.27 | $67.75 | RVU14D |
| 2014-07-01 | $106.27 | $67.75 | RVU14C |
| 2014-04-01 | $106.27 | $67.75 | RVU14B |
| 2014-01-01 | $106.27 | $67.75 | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Metropolitan Boston, MA rate applies
Metropolitan Boston, MA is a Medicare payment area, not a city. Our Census mapping connects it to 60 cities and communities in Massachusetts. Some span more than one payment area; confirm with the service ZIP.
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
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