CPT 99461: Newborn careMedicare rate & RVUs
Initial daily evaluation and management of a normal newborn in an office, home, or other setting outside a hospital or birthing center.
Medicare pays $93.86 for 99461 nationally in the office and $53.11 in a hospital or facility. Local office rates run $85.75–$119.25.
Medicare rate · 99461
Newborn care
Swap in your local Medicare rate.
- Work RVUs
- 1.26
- Total RVUs
- 2.81
- Global days
- XXX
National rate · 2026
$93.86
Office setting, before claim adjustments.
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 10 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.
Where 99461 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$85.75 to $119.25
109 of 109 payment localities
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
Swap in your local Medicare rate.
Work 1.26Practice expense 1.48Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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).
Non-facility (office) rate · national
$93.86
The facility rate would be $53.11 (+$40.75). In a facility, the facility bills its own costs separately.
99461 compared with similar codes
Compare codes
99461 vs 99460 vs 99462 vs 99463: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99460Newborn care
- Use 99460 for initial care of a normal newborn in a hospital or birthing center; use 99461 when that initial care occurs elsewhere.
- 99462Newborn care
- 99462 describes subsequent daily newborn care in a hospital or birthing center, rather than initial care in a non-facility setting.
- 99463Newborn care
- 99463 represents newborn care with same-day admission and discharge in a hospital or birthing center; 99461 is initial care outside those settings.
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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