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CMS RVU26D · Effective 2026-10-01

99461 in Austin

Office / nonfacility

$96.54

Base rate per service

Facility setting

$53.43

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Newborn evaluation and management

About 99461: Initial normal newborn care outside hospital

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

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.

Where the value comes from

  • Work RVU1.26 · 45%
  • Practice expense (office) RVU1.48 · 53%
  • Malpractice RVU0.07 · 2%

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.

99461 compared with similar codes

Office rates for Austin, from the same CMS release.

99460

Newborn care

Initial hospital day

No office rate

Use 99460 for initial care of a normal newborn in a hospital or birthing center; use 99461 when that initial care occurs elsewhere.

99462

Newborn care

Subsequent hospital day

No office rate

99462 describes subsequent daily newborn care in a hospital or birthing center, rather than initial care in a non-facility setting.

99463

Newborn care

Admission and discharge same day

No office rate

99463 represents newborn care with same-day admission and discharge in a hospital or birthing center; 99461 is initial care outside those settings.

The same code, a different location

How does Austin compare?

In Beaumont, the office rate for 99461 is $89.24—$7.30 lower than the $96.54 rate in Austin. Both use the same code, release and participation basis.

99461 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    $96.54

  2. Beaumont

    $89.24

    $7.30 lower than Austin

  3. Brazoria

    $93.23

    $3.31 lower than Austin

  4. Dallas

    $93.71

    $2.83 lower than Austin

  5. Fort Worth

    $93.24

    $3.30 lower than Austin

  6. Galveston

    $93.45

    $3.09 lower than Austin

  7. Houston

    $94.73

    $1.81 lower than Austin

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 99461 ranges from $85.75 in Arkansas to $119.25 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Rest Of Texas

    Texas · 99461

    Office

    $91.11

    Facility

    $52.44

    $5.43 lower than Austin for the office setting.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 99461

    Office

    $103.84

    Facility

    $55.64

    $7.30 higher than Austin for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 99461

    Office

    $105.19

    Facility

    $57.19

    $8.65 higher than Austin for the office setting.

  • Miami

    Florida · 99461

    Office

    $99.46

    Facility

    $57.04

    $2.92 higher than Austin for the office setting.

  • Chicago

    Illinois · 99461

    Office

    $97.43

    Facility

    $56.47

    $0.89 higher than Austin for the office setting.

  • Manhattan

    New York · 99461

    Office

    $105.93

    Facility

    $58.58

    $9.39 higher than Austin for the office setting.

  • Alaska*

    Alaska · 99461

    Office

    $117.06

    Facility

    $73.66

    $20.52 higher than Austin for the office setting.

  • Alabama

    Alabama · 99461

    Office

    $86.66

    Facility

    $51.01

    $9.88 lower than Austin for the office setting.

  • Arkansas

    Arkansas · 99461

    Office

    $85.75

    Facility

    $50.75

    $10.79 lower than Austin for the office setting.

  • Arizona

    Arizona · 99461

    Office

    $91.99

    Facility

    $52.50

    $4.55 lower than Austin for the office setting.

  • Bakersfield

    California · 99461

    Office

    $98.49

    Facility

    $53.83

    $1.95 higher than Austin for the office setting.

  • Chico

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • El Centro

    California · 99461

    Office

    $98.24

    Facility

    $53.58

    $1.70 higher than Austin for the office setting.

  • Fresno

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Hanford-Corcoran

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Madera

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Merced

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Modesto

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Napa

    California · 99461

    Office

    $111.08

    Facility

    $57.37

    $14.54 higher than Austin for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 99461

    Office

    $103.15

    Facility

    $54.98

    $6.61 higher than Austin for the office setting.

  • Redding

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Rest Of California

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 99461

    Office

    $99.02

    Facility

    $54.35

    $2.48 higher than Austin for the office setting.

  • Sacramento-Roseville-Folsom

    California · 99461

    Office

    $102.34

    Facility

    $54.95

    $5.80 higher than Austin for the office setting.

  • Salinas

    California · 99461

    Office

    $101.94

    Facility

    $54.71

    $5.40 higher than Austin for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 99461

    Office

    $103.74

    Facility

    $55.00

    $7.20 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 99461

    Office

    $116.86

    Facility

    $59.40

    $20.32 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 99461

    Office

    $116.78

    Facility

    $59.32

    $20.24 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 99461

    Office

    $119.25

    Facility

    $60.49

    $22.71 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 99461

    Office

    $118.93

    Facility

    $60.17

    $22.39 higher than Austin for the office setting.

  • San Luis Obispo-Paso Robles

    California · 99461

    Office

    $100.36

    Facility

    $53.95

    $3.82 higher than Austin for the office setting.

  • Santa Cruz-Watsonville

    California · 99461

    Office

    $104.28

    Facility

    $54.77

    $7.74 higher than Austin for the office setting.

  • Santa Maria-Santa Barbara

    California · 99461

    Office

    $102.16

    Facility

    $54.64

    $5.62 higher than Austin for the office setting.

  • Santa Rosa-Petaluma

    California · 99461

    Office

    $105.31

    Facility

    $55.27

    $8.77 higher than Austin for the office setting.

  • Stockton

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Vallejo

    California · 99461

    Office

    $110.96

    Facility

    $57.26

    $14.42 higher than Austin for the office setting.

  • Visalia

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Yuba City

    California · 99461

    Office

    $98.23

    Facility

    $53.57

    $1.69 higher than Austin for the office setting.

  • Colorado

    Colorado · 99461

    Office

    $97.01

    Facility

    $53.66

    $0.47 higher than Austin for the office setting.

  • Connecticut

    Connecticut · 99461

    Office

    $99.00

    Facility

    $55.11

    $2.46 higher than Austin for the office setting.

  • Delaware

    Delaware · 99461

    Office

    $93.24

    Facility

    $52.98

    $3.30 lower than Austin for the office setting.

  • Fort Lauderdale

    Florida · 99461

    Office

    $96.39

    Facility

    $55.11

    $0.15 lower than Austin for the office setting.

  • Rest Of Florida

    Florida · 99461

    Office

    $92.86

    Facility

    $53.90

    $3.68 lower than Austin for the office setting.

  • Atlanta

    Georgia · 99461

    Office

    $95.24

    Facility

    $53.84

    $1.30 lower than Austin for the office setting.

  • Rest Of Georgia

    Georgia · 99461

    Office

    $88.97

    Facility

    $52.62

    $7.57 lower than Austin for the office setting.

  • Hawaii, Guam

    Hawaii · 99461

    Office

    $99.64

    Facility

    $53.31

    $3.10 higher than Austin for the office setting.

  • Iowa

    Iowa · 99461

    Office

    $88.24

    Facility

    $50.96

    $8.30 lower than Austin for the office setting.

  • Idaho

    Idaho · 99461

    Office

    $88.67

    Facility

    $51.18

    $7.87 lower than Austin for the office setting.

  • East St. Louis

    Illinois · 99461

    Office

    $92.27

    Facility

    $54.78

    $4.27 lower than Austin for the office setting.

  • Rest Of Illinois

    Illinois · 99461

    Office

    $90.87

    Facility

    $53.67

    $5.67 lower than Austin for the office setting.

  • Suburban Chicago

    Illinois · 99461

    Office

    $97.29

    Facility

    $55.44

    $0.75 higher than Austin for the office setting.

  • Indiana

    Indiana · 99461

    Office

    $89.05

    Facility

    $51.27

    $7.49 lower than Austin for the office setting.

  • Kansas

    Kansas · 99461

    Office

    $87.95

    Facility

    $51.11

    $8.59 lower than Austin for the office setting.

  • Kentucky

    Kentucky · 99461

    Office

    $88.17

    Facility

    $51.94

    $8.37 lower than Austin for the office setting.

  • New Orleans

    Louisiana · 99461

    Office

    $91.26

    Facility

    $52.91

    $5.28 lower than Austin for the office setting.

  • Rest Of Louisiana

    Louisiana · 99461

    Office

    $88.07

    Facility

    $52.01

    $8.47 lower than Austin for the office setting.

  • Metropolitan Boston

    Massachusetts · 99461

    Office

    $104.91

    Facility

    $56.26

    $8.37 higher than Austin for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 99461

    Office

    $96.68

    Facility

    $53.77

    $0.14 higher than Austin for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 99461

    Office

    $98.69

    Facility

    $54.97

    $2.15 higher than Austin for the office setting.

  • Rest Of Maryland

    Maryland · 99461

    Office

    $94.68

    Facility

    $53.44

    $1.86 lower than Austin for the office setting.

  • Rest Of Maine

    Maine · 99461

    Office

    $89.02

    Facility

    $51.53

    $7.52 lower than Austin for the office setting.

  • Southern Maine

    Maine · 99461

    Office

    $92.55

    Facility

    $52.17

    $3.99 lower than Austin for the office setting.

  • Detroit

    Michigan · 99461

    Office

    $93.73

    Facility

    $54.41

    $2.81 lower than Austin for the office setting.

  • Rest Of Michigan

    Michigan · 99461

    Office

    $89.86

    Facility

    $52.65

    $6.68 lower than Austin for the office setting.

  • Minnesota

    Minnesota · 99461

    Office

    $93.64

    Facility

    $51.71

    $2.90 lower than Austin for the office setting.

  • Metropolitan Kansas City

    Missouri · 99461

    Office

    $90.79

    Facility

    $52.52

    $5.75 lower than Austin for the office setting.

  • Metropolitan St. Louis

    Missouri · 99461

    Office

    $91.49

    Facility

    $52.70

    $5.05 lower than Austin for the office setting.

  • Rest Of Missouri

    Missouri · 99461

    Office

    $86.97

    Facility

    $51.85

    $9.57 lower than Austin for the office setting.

  • Mississippi

    Mississippi · 99461

    Office

    $86.38

    Facility

    $51.29

    $10.16 lower than Austin for the office setting.

  • Montana**

    Montana · 99461

    Office

    $93.85

    Facility

    $53.10

    $2.69 lower than Austin for the office setting.

  • North Carolina

    North Carolina · 99461

    Office

    $89.70

    Facility

    $51.68

    $6.84 lower than Austin for the office setting.

  • North Dakota**

    North Dakota · 99461

    Office

    $92.47

    Facility

    $51.72

    $4.07 lower than Austin for the office setting.

  • Nebraska

    Nebraska · 99461

    Office

    $88.60

    Facility

    $50.98

    $7.94 lower than Austin for the office setting.

  • New Hampshire

    New Hampshire · 99461

    Office

    $95.59

    Facility

    $53.17

    $0.95 lower than Austin for the office setting.

  • Northern Nj

    New Jersey · 99461

    Office

    $104.58

    Facility

    $57.31

    $8.04 higher than Austin for the office setting.

  • Rest Of New Jersey

    New Jersey · 99461

    Office

    $100.31

    Facility

    $55.82

    $3.77 higher than Austin for the office setting.

  • New Mexico

    New Mexico · 99461

    Office

    $90.22

    Facility

    $52.86

    $6.32 lower than Austin for the office setting.

  • Nevada**

    Nevada · 99461

    Office

    $93.52

    Facility

    $52.73

    $3.02 lower than Austin for the office setting.

  • Nyc Suburbs/Long Island

    New York · 99461

    Office

    $107.90

    Facility

    $59.45

    $11.36 higher than Austin for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 99461

    Office

    $100.94

    Facility

    $56.32

    $4.40 higher than Austin for the office setting.

  • Queens

    New York · 99461

    Office

    $106.58

    Facility

    $58.41

    $10.04 higher than Austin for the office setting.

  • Rest Of New York

    New York · 99461

    Office

    $90.69

    Facility

    $51.98

    $5.85 lower than Austin for the office setting.

  • Ohio

    Ohio · 99461

    Office

    $89.57

    Facility

    $52.37

    $6.97 lower than Austin for the office setting.

  • Oklahoma

    Oklahoma · 99461

    Office

    $88.05

    Facility

    $51.66

    $8.49 lower than Austin for the office setting.

  • Portland

    Oregon · 99461

    Office

    $99.42

    Facility

    $54.15

    $2.88 higher than Austin for the office setting.

  • Rest Of Oregon

    Oregon · 99461

    Office

    $92.96

    Facility

    $52.38

    $3.58 lower than Austin for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 99461

    Office

    $97.09

    Facility

    $54.67

    $0.55 higher than Austin for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 99461

    Office

    $89.67

    Facility

    $52.27

    $6.87 lower than Austin for the office setting.

  • Puerto Rico

    Puerto Rico · 99461

    Office

    $94.37

    Facility

    $53.17

    $2.17 lower than Austin for the office setting.

  • Rhode Island

    Rhode Island · 99461

    Office

    $96.03

    Facility

    $53.94

    $0.51 lower than Austin for the office setting.

  • South Carolina

    South Carolina · 99461

    Office

    $89.75

    Facility

    $52.10

    $6.79 lower than Austin for the office setting.

  • South Dakota**

    South Dakota · 99461

    Office

    $92.30

    Facility

    $51.55

    $4.24 lower than Austin for the office setting.

  • Tennessee

    Tennessee · 99461

    Office

    $88.28

    Facility

    $51.23

    $8.26 lower than Austin for the office setting.

  • Utah

    Utah · 99461

    Office

    $90.65

    Facility

    $52.35

    $5.89 lower than Austin for the office setting.

  • Virginia

    Virginia · 99461

    Office

    $92.33

    Facility

    $52.27

    $4.21 lower than Austin for the office setting.

  • Virgin Islands

    United States Virgin Islands · 99461

    Office

    $94.37

    Facility

    $53.17

    $2.17 lower than Austin for the office setting.

  • Vermont

    Vermont · 99461

    Office

    $92.21

    Facility

    $51.87

    $4.33 lower than Austin for the office setting.

  • Rest Of Washington

    Washington · 99461

    Office

    $96.46

    Facility

    $53.56

    $0.08 lower than Austin for the office setting.

  • Seattle (King Cnty)

    Washington · 99461

    Office

    $106.75

    Facility

    $56.76

    $10.21 higher than Austin for the office setting.

  • Wisconsin

    Wisconsin · 99461

    Office

    $90.16

    Facility

    $51.12

    $6.38 lower than Austin for the office setting.

  • West Virginia

    West Virginia · 99461

    Office

    $88.39

    Facility

    $52.98

    $8.15 lower than Austin for the office setting.

  • Wyoming**

    Wyoming · 99461

    Office

    $93.25

    Facility

    $52.50

    $3.29 lower than Austin for the office setting.

See how rates vary across the country

99461 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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 all state and territory rates as a table
State / territoryRate 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

Explore 99461 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Texas →

Why are the office and facility amounts different?

For 99461 in Austin, the physician’s office rate is $96.54 and the facility-setting rate is $53.43: a difference of $43.11.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 99461 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$106.19

$96.54 × 110% = $106.19

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99461 in Austin.

PPRRVU2026_Oct_nonQPP.csv

13,128

Code
99461
Physician work
1.26
Practice expense
1.48
Malpractice
0.07

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Office / nonfacility calculation for 99461 in Austin
ComponentRVULocality factorAdjusted
Physician work1.26× 1.0021.2625
Practice expense1.48× 1.0581.5658
Malpractice0.07× 0.8860.0620
Total RVUs2.8904
Conversion factor× 33.4009

Office / nonfacility rate, Austin$96.54

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 99461 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.261.002
Practice expense1.481.058
Malpractice0.070.886

(1.26 × 1.002 + 1.48 × 1.058 + 0.07 × 0.886) × $33.4009 = $96.54

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.261.002
Practice expense0.261.058
Malpractice0.070.886

(1.26 × 1.002 + 0.26 × 1.058 + 0.07 × 0.886) × $33.4009 = $53.43

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

99461 · Office / nonfacility

$96.54

Effective 2026-10-01

The base rate is $6.05 higher than on 2025-10-01, moving from $90.49 to $96.54 (6.7%).

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

    $90.49changed to$96.54

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 1.046 changed to 1.058
    • Malpractice GPCI 0.914 changed to 0.886

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $90.49

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$96.54$53.43RVU26D
2026-07-01$96.54$53.43RVU26C
2026-04-01$96.54$53.43RVU26B
2026-01-01$96.54$53.43RVU26A
2025-10-01$90.49$58.69RVU25D
2025-07-01$90.49$58.69RVU25C
2025-04-01$90.49$58.69RVU25B
2025-01-01$90.49$58.69RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 99461PPRRVU2026_Oct_nonQPP.csv, line 13,128 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet