2025 CPT code 99462
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Newborn Care Services Evaluation and Management Feed
Subsequent hospital care, per day, for evaluation and management of a normal newborn.
Modifier 25 may be appended if a significant, separately identifiable evaluation and management service is performed on the same day as the routine newborn care.
Medical necessity is established by the need for daily monitoring and assessment of the well-being of a normal newborn during the initial hospital stay. The purpose is to ensure the infant is transitioning smoothly to life outside the womb and to address any potential early complications. The visit is medically necessary for preventative care.
The provider's responsibility includes conducting a comprehensive assessment of the newborn's well-being, monitoring vital signs, evaluating feeding and elimination patterns, assessing weight gain or loss, and providing parental education regarding newborn care.This also includes observing the mother-infant bonding process and monitoring the healing of the umbilical cord.
In simple words: This code covers the doctor's daily checkups of a healthy newborn baby in the hospital after the baby's first exam. The doctor watches the baby's growth, feeding, and other important things, and teaches the parents how to care for their baby.
This CPT code reports the daily evaluation and management services provided to a normal newborn infant during their hospital stay after the initial hospital evaluation.These services include monitoring the newborn's feeding, reviewing vital signs, assessing weight changes, bowel and bladder function, sleep patterns, observing mother-infant bonding, monitoring umbilical cord healing, and providing parental education on newborn care.The newborn should not require significant intervention or have any medical conditions necessitating special care.
Example 1: A healthy newborn is admitted to the hospital.On day 2, the provider performs a routine checkup, including assessing feeding, weight, and vital signs, and instructing the parents on diapering and swaddling techniques. Code 99462 is used to bill for this daily visit., A healthy newborn is admitted, and the provider performs the initial hospital care, followed by a daily checkup (99462) on day 3. During this visit, the provider notices the infant's temperature is slightly elevated, requiring additional evaluation and treatment. Modifier 25 is appended to code 99462 to indicate the separately identifiable evaluation and management service related to the fever., A healthy newborn is admitted to the hospital and receives routine follow-up care (99462) each day for four days.On the fourth day, a circumcision is performed. Code 99462 is billed for the routine visits, and code 54150 is separately billed for the circumcision.
Detailed documentation should include the date and time of the visit, a complete assessment of the newborn's vital signs, feeding patterns, weight, output (urine and stool), sleep patterns, and observation of mother-infant bonding.Documentation should also detail any parental education provided and any interventions or treatments performed.
** This code is specifically for subsequent days of hospital care for normal newborns after the initial hospital evaluation.It should not be used for the initial evaluation and management of the newborn in the delivery room or on the first day after birth.Appropriate documentation is crucial to justify the medical necessity of the daily visits.
- Payment Status: Active
- Specialties:Neonatology, Pediatrics
- Place of Service:Inpatient Hospital