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    v1.0.30
    OpenPayerBilling CodesNewborn Care ServicesCPT cpt-99461-newborn-evaluation-immediately-after-birth-non-hospital
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    CPT 99461: Newborn Evaluation Outside Hospital

    Medicare pays $97 on average nationally for this procedure.

    CPT code 99461 describes the provider evaluation and management of a normal newborn infant immediately after birth when that care is delivered outside a hospital or birthing center, typically in a home or outpatient setting; the service type is newborn initial evaluation and care and the typical site of service is location other than hospital/birthing center.

    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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    Clinical & Coding Specifications

    Clinical Context

    A primary care pediatrician or neonatologist performs an immediate postpartum newborn evaluation in an outpatient setting such as a private physician office, home visit, or clinic when the infant was delivered outside a hospital or birthing center. A typical scenario: a full-term infant born at home by a midwife is brought to the pediatrician within the first 24 hours for the initial newborn assessment. The clinician documents birth history, Apgar scores if available, feeding status, thermoregulation, vital signs, weight/length/head circumference, physical examination including cardiac, respiratory, abdominal, neurologic, skin, and umbilical cord inspection, and counseling to the parent(s) about feeding, safe sleep, newborn screening, and when to seek urgent care. If needed, the provider arranges referral to pediatric specialty care, initiates newborn screening orders, and documents immunization plan. The service is reported with 99461 when the provider evaluates and manages the normal newborn at a location other than a hospital or birthing center, per CPT definition. Parental consent, time of encounter, and any procedures performed (for example, circumcision performed separately) are documented in the medical record.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99460Initial hospital or birthing center care of the normal newborn infant, per day, which includes routine newborn care in the hospital settingAlternative code used when the newborn evaluation occurs in a hospital or birthing center rather than an outpatient location.
    99463Initial home visit for evaluation and management of a normal newborn infantUsed when the newborn visit is performed in the infant's home; reported instead of 99461 when the setting is clearly a home visit.
    99464Attendance at delivery, when requested by the delivering practitioner, to provide immediate neonatal care (separate procedure)Used for immediate attendance at delivery when the clinician provides neonatal resuscitation or stabilization at birth, distinct from the subsequent outpatient newborn visit.
    99465Hospital or birthing center attendance for high-risk newborn resuscitation or stabilizationUsed when higher acuity resuscitation or stabilization is performed in a hospital or birthing center setting; distinct from routine outpatient newborn evaluation.
    99471Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill newbornUsed when the newborn requires critical care services in an inpatient setting, not reportable with 99461.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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.,…
    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…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    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
    207Q00000X
    208000000X
    207L00000X
    363LF0000X
    367500000X
    224Z00000X
    1835I0206X
    1710I1002X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    P03.1Newborn affected by other malpresentation, malposition and disproportion during labor and delivery
    P05.2Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age
    P07.23Extreme immaturity of newborn, gestational age 24 completed weeks
    P07.30Preterm newborn, unspecified weeks of gestation
    P07.31Preterm newborn, gestational age 28 completed weeks
    P07.32Preterm newborn, gestational age 29 completed weeks
    P07.33Preterm newborn, gestational age 30 completed weeks
    P22.0Respiratory distress syndrome of newborn
    P28.5Respiratory failure of newborn
    P59.0Neonatal jaundice associated with preterm delivery

    Showing 1–10 of 22

    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-99460-NEWBORN-INITIAL-EVALUATION-HOSPITAL-BIRTHING-CENTER

    CPT 99460: Initial Evaluation of Normal Newborn Immediately After Birth

    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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