CPT 99460: Initial Evaluation of Normal Newborn Immediately After Birth
Medicare pays $83 and commercial payers pay $187 on average nationally for this procedure.
CPT code 99460 describes the initial evaluation and management of a normal newborn infant typically performed immediately after birth by a qualified provider; this is an initial newborn E/M service provided in a hospital or birthing center setting and documents the clinician’s assessment, stabilization, and routine care of the newborn shortly after delivery.
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National Reimbursement Benchmarks
Commercial averages sit well above Medicare: BUCA’s mean commercial rate is $187.50 compared with Medicare’s mean of $82.50, a gap of $105.00 that highlights material upward pressure in negotiated commercial payments versus the fee schedule. Blue Cross Blue Shield and UnitedHealth Group show higher mean levels ($222.80 and $144.30 respectively), while Aetna and Cigna have similar means near $138; these differences reflect insurer-specific positioning relative to the commercial average.
Dispersion varies notably by payer. Blue Cross Blue Shield has the widest interquartile spread at $87.70 (P75 $266.80 minus P25 $179.10), indicating greater variability in midpoint commercial rates, while Aetna’s spread is $98.20? Wait, recalc Aetna: P75 $182.10 minus P25 $83.90 equals $98.20 — that makes Aetna the widest. UnitedHealth Group’s IQR is $87.00 (P75 $182.00 minus P25 $93.60), Cigna’s is $90.70, and BUCA’s IQR is $89.80, placing UnitedHealth Group relatively tightest and Aetna the widest among listed payers.