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    v1.0.30
    OpenPayerBilling CodesNewborn Care ServicesCPT cpt-99462-subsequent-newborn-evaluation-inpatient
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    CPT 99462: Subsequent Hospital Evaluation of Normal Newborn

    Medicare pays $36 and commercial payers pay $57 on average nationally for this procedure.

    CPT code 99462 describes the provider evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation, representing a subsequent newborn hospital care service typically provided at the inpatient hospital or birthing center setting for routine daily clinical assessment and management of a well newborn after the initial post-delivery encounter.

    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 are substantially higher than Medicare: BUCA’s mean commercial rate is $57.10 versus Medicare’s mean of $36.20, a spread of $20.90 that highlights the pricing gap between commercial contracts and the federal fee schedule for CPT 99462. Blue Cross Blue Shield ($51.30 mean), Aetna ($62.30 mean), Cigna ($62.10 mean) and UnitedHealth Group ($64.20 mean) cluster around BUCA’s average, with UnitedHealth Group at the high end of that commercial band.

    Dispersion varies materially across payers when measured by the interquartile range (P75–P25). Blue Cross Blue Shield shows the tightest IQR at $17.00, while Aetna and UnitedHealth Group are wider at $44.00 and $38.20 respectively; Cigna’s IQR is $38.50 and BUCA’s is $33.00. Medicare’s IQR is narrowest at $2.00, reflecting low local variation across its 47 localities. These spread differences indicate where commercial rates concentrate or diverge relative to Medicare.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A newborn delivered in a hospital maternity ward receives routine ongoing medical assessment after the initial post-delivery evaluation. A pediatric or neonatal-perinatal medicine physician documents daily evaluation and management on a day subsequent to the initial hospital evaluation for a normal newborn. Typical workflow: the delivering obstetric team notifies the pediatric service of a stable infant with diagnosis codes such as Z38.00 or Z38.01; the newborn is examined for transition, feeding, thermoregulation, weight, elimination, and screening results. On subsequent hospital days the physician performs focused history since prior exam, interval physical exam, reviews nursing notes, laboratory or bilirubin trends (P59.9), respiratory status (P28.5), and documents plans. For a preterm infant (P07.30) or neonate with transient issues, the provider may extend monitoring and daily E/M documentation. Typical site of service is an inpatient hospital newborn nursery or neonatal intermediate care unit. The typical patient scenario: a term or near-term single liveborn infant delivered vaginally (Z38.00) remains for routine observation; on hospital day 1 the attending pediatrician performs the subsequent hospital care documented as 99462 for the evaluation and management of a normal newborn.

    Related CPT Codes

    CPT Code

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    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…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    2080N0001X
    2080P0201X
    3336C0004X
    364SN0000X
    261Q00000X
    1835C0206X
    1744R1103X

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

    CPT 99461: Newborn Evaluation Outside Hospital

    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 powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    Description
    Relationship to This Procedure
    99460Initial hospital or birthing center care, per day, for evaluation and management of normal newbornPerformed on the first hospital day; precedes 99462 which is used on subsequent days
    99461Subsequent hospital care, per day, for evaluation and management of normal newborn by other than the staff physician or under referralUsed when the E/M is provided by a covering or consulting physician other than the primary attending
    99463Subsequent hospital care, per day, for evaluation and management of normal newborn requiring care with additional high complexityUsed when the subsequent newborn care requires higher complexity and additional time or resources compared with 99462