2025 CPT code 99463
Effective Date: N/A Evaluation and Management - Newborn Care Services Feed
Initial hospital or birthing center care, per day, for the evaluation and management of a normal newborn infant admitted and discharged on the same date.
Modifier 25 can be appended to 99463 if a separately identifiable E/M service is performed on the same day, such as if the newborn's condition changes and requires additional care.
Medical necessity for 99463 is established by the need for a physician to evaluate and manage the care of a normal newborn infant immediately after birth until discharge from the hospital or birthing center on the same day.
The physician is responsible for clearing the infant's airway, ligating the umbilical cord, reviewing maternal and newborn history, performing a physical exam, ordering tests/treatments, discussing findings with the family, documenting everything, and providing discharge instructions.
In simple words: This code covers the doctor's care for a healthy newborn baby at the hospital or birthing center, from birth until they go home the same day. This includes checking the baby, talking to the family, and doing any necessary tests.
This code covers the evaluation and management services provided to a normal newborn infant in the initial days after birth, prior to discharge from the hospital or birthing center on the same date of admission.It includes the maternal and/or fetal and newborn history review, newborn physical examination(s), ordering of diagnostic tests and treatments, meetings with the family, and documentation in the medical record.This code does not include delivery room attendance (99464), delivery room resuscitation (99465), or procedures like circumcision (54150), which are reported separately. For newborns requiring intensive or critical care, use codes 99221-99233 or 99466-99469 and 99477-99480. If a normal newborn later requires intensive care on the same day, append modifier 25 to 99463.For follow-up care after discharge, use codes 99202-99215, 99381, or 99391.
Example 1: A healthy newborn is born at a birthing center and is discharged the same day. The physician performs a complete examination, reviews the mother's history, and provides discharge instructions. Code 99463 is used., A newborn is born with a minor breathing issue requiring brief observation but does not necessitate intensive care. The physician performs the initial care, monitors the baby for several hours, and discharges them the same day. Code 99463 is reported., A normal newborn is delivered and receives initial care. Later that day, the newborn develops jaundice requiring phototherapy. The initial care is billed with 99463, and the subsequent care for jaundice is billed separately with the appropriate code and modifier 25 applied to 99463.
Documentation should include a detailed record of the newborn's examination, including vital signs, physical findings, any procedures performed (e.g., umbilical cord ligation), maternal history, discussions with the family, and discharge instructions. If diagnostic tests are ordered, the results should also be documented.
- Specialties:Pediatrics, Family Medicine, Obstetrics/Gynecology
- Place of Service:Inpatient Hospital, Birthing Center