CPT 99461

1st Care Pr Day Nml Nb Xcpt Hosp/Birthing Center

CPT 99461 pays $93.86 in a non-facility setting and $53.11 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $85.75 in Arkansas to $117.06 in Alaska, a 37% spread.

National non-facility rate

$93.86

Office and other outpatient settings

Facility rate
$53.11

Hospital and ASC settings

Highest state
$117.06

Alaska

Lowest state
$85.75

Arkansas · 37% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $93.86
CPT 99461 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $93.86, national facility $53.11.
StateRate compared visuallyNon-facilityFacility
Alaska
$117.06$73.66
District of Columbia
$105.19$57.19
California
$103.35$55.14
New Jersey
$102.45$56.56
New York
$102.41$56.95
Washington
$101.61$55.16
Massachusetts
$100.80$55.01
Hawaii
$99.64$53.31
Connecticut
$99.00$55.11
Colorado
$97.01$53.66
Maryland
$96.69$54.20
Florida
$96.23$55.35
Oregon
$96.19$53.26
Rhode Island
$96.03$53.94
New Hampshire
$95.59$53.17
Illinois
$94.47$55.09
Puerto Rico
$94.37$53.17
Virgin Islands
$94.37$53.17
Montana
$93.85$53.10
Minnesota
$93.64$51.71
Nevada
$93.52$52.73
Pennsylvania
$93.38$53.47
Wyoming
$93.25$52.50
Delaware
$93.24$52.98
Texas
$93.16$53.04
North Dakota
$92.47$51.72
Virginia
$92.33$52.27
South Dakota
$92.30$51.55
Vermont
$92.21$51.87
Georgia
$92.11$53.23
Arizona
$91.99$52.50
Michigan
$91.79$53.53
Maine
$90.78$51.85
Utah
$90.65$52.35
New Mexico
$90.22$52.86
Wisconsin
$90.16$51.12
Missouri
$89.75$52.36
South Carolina
$89.75$52.10
North Carolina
$89.70$51.68
Louisiana
$89.67$52.46
Ohio
$89.57$52.37
Indiana
$89.05$51.27
Idaho
$88.67$51.18
Nebraska
$88.60$50.98
West Virginia
$88.39$52.98
Tennessee
$88.28$51.23
Iowa
$88.24$50.96
Kentucky
$88.17$51.94
Oklahoma
$88.05$51.66
Kansas
$87.95$51.11
Alabama
$86.66$51.01
Mississippi
$86.38$51.29
Arkansas
$85.75$50.75

Billed by 2 specialties

Commercial rates for 99461

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates