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.
On this page
CMS RVU26D · Effective 2026-10-01
99461 Newborn care Medicare reimbursement rates in Tennessee
Initial daily evaluation and management of a normal newborn in an office, home, or other setting outside a hospital or birthing center. Compare 99461 office and facility rates across CMS payment localities in Tennessee.
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.
What does Medicare pay for 99461 in Tennessee?
Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$88.28
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
Facility setting
$51.23
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Tennessee, from the same CMS release.
No office rate
99462 describes subsequent daily newborn care in a hospital or birthing center, rather than initial care in a non-facility setting.
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.
Compare 99461 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Tennessee →
Office / nonfacility
$88.28
Facility
$51.23
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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 Tennessee.
PPRRVU2026_Oct_nonQPP.csv
13,128
- Code
- 99461
- Physician work
- 1.26
- Practice expense
- 1.48
- Malpractice
- 0.07
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.26 | × 1.000 | 1.2600 |
| Practice expense | 1.48 | × 0.909 | 1.3453 |
| Malpractice | 0.07 | × 0.537 | 0.0376 |
| Total RVUs | 2.6429 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Tennessee$88.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.26 | 1 |
| Practice expense | 1.48 | 0.909 |
| Malpractice | 0.07 | 0.537 |
(1.26 × 1 + 1.48 × 0.909 + 0.07 × 0.537) × $33.4009 = $88.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.26 | 1 |
| Practice expense | 0.26 | 0.909 |
| Malpractice | 0.07 | 0.537 |
(1.26 × 1 + 0.26 × 0.909 + 0.07 × 0.537) × $33.4009 = $51.23
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.
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.
13,12599458,,Rpm tx mgmt ea addl 20 min,A,,0.61,0.59,,0.14,,0.04,1.24,0.79,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12699459,,Pelvic examination,A,,0.00,0.52,,0.52,NA,0.00,0.52,0.52,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12799460,,Init nb em per day hosp,A,,1.92,0.38,NA,0.38,,0.12,2.42,2.42,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12899461,,Init nb em per day non-fac,A,,1.26,1.48,,0.26,,0.07,2.81,1.59,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12999462,,Sbsq nb em per day hosp,A,,0.84,0.17,NA,0.17,,0.05,1.06,1.06,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13099463,,Same day nb discharge,A,,2.13,0.58,NA,0.58,,0.13,2.84,2.84,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,13199464,,Attendance at delivery,A,,1.50,0.31,NA,0.31,,0.08,1.89,1.89,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780