# CPT 99461: 1st Care Pr Day Nml Nb Xcpt Hosp/birthing Center

Medicare 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.

Web page: https://www.med-reveal.com/rates/99461-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation, Pediatrics

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $93.86 |
| National facility | $53.11 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $117.06 | $73.66 |
| District of Columbia | $105.19 | $57.19 |
| California | $103.35 | $55.14 |
| New Jersey | $102.45 | $56.57 |
| New York | $102.41 | $56.95 |
| Washington | $101.60 | $55.16 |
| Massachusetts | $100.80 | $55.02 |
| Hawaii | $99.64 | $53.31 |
| Connecticut | $99.00 | $55.11 |
| Colorado | $97.01 | $53.66 |
| Maryland | $96.69 | $54.21 |
| Florida | $96.24 | $55.35 |
| Oregon | $96.19 | $53.27 |
| 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 | $92.10 | $53.23 |
| Arizona | $91.99 | $52.50 |
| Michigan | $91.80 | $53.53 |
| Maine | $90.79 | $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 |

## Related codes

- 99201: New Patient Office Visit: Coverage and Documentation Requirements — https://www.med-reveal.com/rates/99201-cpt-fee-schedule
- 99241: Office consultation for a new or established patient that requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making — https://www.med-reveal.com/rates/99241-cpt-fee-schedule
- 99251: Inpatient consultation for a new or established patient which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. — https://www.med-reveal.com/rates/99251-cpt-fee-schedule
- 99288: Phys/qhp Direction Emergency Medical Systems — https://www.med-reveal.com/rates/99288-cpt-fee-schedule
- 99354: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99354-cpt-fee-schedule
- 99355: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99355-cpt-fee-schedule
- 99358: Prolng E/m Svc Before&/after Dir Pt Care 1st Hr — https://www.med-reveal.com/rates/99358-cpt-fee-schedule
- 99359: Prolng E/m Before&/after Dir Care Ea 30 Minutes — https://www.med-reveal.com/rates/99359-cpt-fee-schedule

Commercial negotiated rates for 99461 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules