99461 initial nb em per day non-fac
Also known as: initial newborn exam non-hospital, newborn office H&P
Initial history and physical examination for newborn care performed by physician per calendar day in non-hospital setting (office, birthing center).
In Plain Language
doctor's first check of your newborn outside hospital
Clinical Context
Used when physician performs initial comprehensive newborn evaluation in outpatient setting such as office or birthing center, typically within 24 hours of delivery.
RVU Breakdown
| Work RVU | 1.26 |
| Total RVU | 1.26 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 1.26, this code ranks in the 35th percentile among Evaluation & Management codes — 1.2x below the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99461?
CPT 99461 (initial nb em per day non-fac) is a Evaluation & Management code. Initial history and physical examination for newborn care performed by physician per calendar day in non-hospital setting (office, birthing center).
Who uses CPT code 99461?
CPT 99461 is used by Pediatrics, Family Medicine, Neonatology. Used when physician performs initial comprehensive newborn evaluation in outpatient setting such as office or birthing center, typically within 24 hours of delivery.
When is CPT 99461 used?
Used when physician performs initial comprehensive newborn evaluation in outpatient setting such as office or birthing center, typically within 24 hours of delivery.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.