CPT code 99463: Newborn care, admission and discharge same day2026 Medicare rate & RVUs

Medicare pays $94.86 for 99463 nationally in a facility.

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

What 99463 covers

This service covers the same-day hospital or birthing-center care of a normal newborn, including the initial evaluation and management and the discharge-related care. It is typically performed by a physician or other qualified clinician responsible for the newborn’s care during the stay. The code is specific to a newborn admitted and discharged on the same calendar date; it is not the selection for a newborn who remains admitted for a later date.

Report one same-day episode for the infant rather than separate newborn-care entries for admission and discharge. Documentation should support the newborn’s normal status, the initial assessment and management, and the same-date admission and discharge. The CMS physician fee schedule assigns physician-work and practice-expense values to this service. Choose among newborn-care codes according to the care setting, whether the service is initial or subsequent, and whether discharge occurs that day.

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.

Where 99463 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99463 rates by state

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

How the 99463 rate is calculated

Each of 99463’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.

Payment rules and modifiers for 99463

99463 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.

99463 compared with similar codes

How to choose

99460Newborn careInitial hospital day

99460 reports initial hospital or birthing-center care without the same-day admission-and-discharge circumstance that defines 99463.

99461Newborn careInitial, non-facility setting

99461 is for initial newborn care outside a hospital or birthing center; 99463 is for the same-day episode in a hospital or birthing center.

99462Newborn careSubsequent hospital day

99462 applies to subsequent daily care when the newborn remains admitted. 99463 covers initial and discharge-related care when both occur on the same date.

Codes related to 99463

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

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

Open CMS sourceHow we calculate rates