CPT 99463: Evaluation and Same-Day Discharge of Normal Newborn
Medicare pays $97 and commercial payers pay $203 on average nationally for this procedure.
CPT code 99463 describes the evaluation and management of a normal newborn infant typically provided immediately after birth through the time of discharge or release later the same day; service type is initial hospital/birthing center newborn care, and the typical site of service is a hospital or birthing center where the newborn is assessed and cleared for same-day discharge.
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National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 99463: Blue Cross Blue Shield and BUCA have notably higher means than Medicare’s mean of $97, with BUCA averaging $202.8 and Blue Cross Blue Shield averaging $236.2. UnitedHealth Group ($169.8), Cigna ($163.4), and Aetna ($141.8) fall between BUCA and Medicare, indicating a clear split between commercial payers and the Medicare baseline.
Dispersion varies meaningfully across payers. Blue Cross Blue Shield shows the widest interquartile spread at $96.0 (P75 $284.8 minus P25 $188.0), while Aetna’s spread is $90.0 (P75 $181.1 minus P25 $90.0). UnitedHealth Group and Cigna have moderate spreads of $100.5 and $102.9 respectively, and BUCA’s interquartile range is $97.3. Medicare is the tightest with a spread of $5 (P75 $99 minus P25 $94).