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    v1.0.30
    OpenPayerBilling CodesNewborn Care ServicesCPT cpt-99460-newborn-initial-evaluation-hospital-birthing-center
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    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.

    For related coverage guidance, see recent payer policy updates: Abortion Services, Prolonged Services for Labor Management, Prolonged Services for Labor Management.

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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.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A term newborn is delivered in a hospital birthing center after an uncomplicated spontaneous vaginal delivery to a 28-year-old G1P1 mother. Immediately after delivery the pediatric or neonatal-perinatal medicine physician performs an initial evaluation of the infant in the delivery room and documents Apgar scores, airway status, tone, color, temperature, vitals, and any resuscitative measures. The provider inspects for congenital anomalies, reviews maternal history (Group B Streptococcus status, prenatal labs, intrapartum course), and initiates routine newborn care including thermoregulation, glucose monitoring if indicated, and vitamin K/eye prophylaxis per hospital protocol. If the infant is stable, the physician documents counseling of the mother regarding feeding and routine newborn care, documents the infant’s physical exam, and records the disposition to the newborn nursery or mother-baby unit. If the infant requires brief resuscitation or observation in the delivery room before transfer, that care is recorded in the newborn EHR entry. Typical workflow steps: delivery → immediate newborn evaluation by the attending pediatrician/neonatologist → documentation of exam and interventions → orders for routine newborn care or specialty consults → transfer to appropriate unit (well-baby, transitional care, or NICU). This scenario aligns with billing 99460 for the initial evaluation and management of a normal newborn infant typically immediately after birth in a hospital or birthing center.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99461

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    2080N0001X
    2080P0201X
    163WP0000X
    2080P0210X
    1835G0000X
    2279G1100X
    372600000X

    Related Payer Policy Updates

    Specialty: Obstetrics/Gynecology1 / 2

    10 rows

    PolicyPayerEffective Date
    Abortion ServicesNew Mexico Health Care Authority2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesBlue Cross Blue Shield - Massachusetts2026-10-01
    Cervical Cancer ScreeningOscar Health2026-10-01
    Prenatal Testing for Fetal AneuploidyOscar Health2026-10-01
    Diagnosis of VaginitisOscar Health2026-10-01
    Prenatal Screening (Nongenetic)Oscar Health2026-10-01

    Related Codes

    CPT-99461-NEWBORN-EVALUATION-IMMEDIATELY-AFTER-BIRTH-NON-HOSPITAL

    CPT 99461: Newborn Evaluation Outside Hospital

    CPT-99462-SUBSEQUENT-NEWBORN-EVALUATION-INPATIENT

    CPT 99462: Subsequent Hospital Evaluation of Normal Newborn

    CPT-99463-NEWBORN-EVALUATION-AND-MANAGEMENT-SAME-DAY-DISCHARGE

    CPT 99463: Evaluation and Same-Day Discharge of Normal Newborn

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Initial hospital or birthing center care per day for normal newborn, first care per day (other than delivery)
    Used for subsequent daily follow-up care of a normal newborn after the initial 99460 encounter when continued E/M is required.
    99462Subsequent hospital care per day for normal newbornUsed for continued daily inpatient care and management in the newborn nursery after the initial evaluation billed with 99460.
    99463Initial hospital or birthing center visit for admit and discharge on same date for a normal newbornUsed when a normal newborn is both admitted and discharged on the same date and the combined encounter meets criteria distinct from 99460.