CPT 59130 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures for Maternity Care and Delivery |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 80 - Assistant surgeon • AG - Primary physician • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 59130 by major payers:
$1,141.54
$1,214.28
$1,197.93
$1,498.39
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 59130 | ||||||
United | 59130 | $425.00 | 1598952061 - ENDOSCOPY ASSOCIATES, LLC | 142006705 - (VA) ENDOSCOPY ASSOCIATES LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $1274.00 | 1942617477 - CENTER FOR ENDOSCOPY LLC | 464958743 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $854.00 | 1295883973 - SUMMIT VENTURES OF SANTA BARBARA, LP, SUMMIT SURGERY CENTER | 770529514 - (CA) SUMMIT VENTURES OF SANTA BARBARA, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $750.00 | 1699745067 - NIAGARA HEALTH CENTER, INC | 391847009 - (WI) NIAGARA HEALTH CENTER | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $450.00 | 1316905680 - OHIO EYE SURGERY CENTER | 311327699 - (OH) OHIO EYE SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $109.00 | 1073588356 - DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA, LLC | 201456252 - (AZ) DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $1559.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $3348.22 | 1508213810 - ALEGENT CREIGHTON HEALTH, CHI HEALTH AMBULATORY SURGERY CENTER AT MIDLANDS | 470757164 - ALEGENT CREIGHTON HEALTH | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $553.00 | 1881002343 - INNOVATIVE SURGERY CENTER, LLC | 471395981 - (MD) INNOVATIVE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $461.00 | 1508862160 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $1028.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $350.00 | 1225221435 - GALLERIA SURGERY CENTER LLC | 731713874 - (MD) GALLERIA SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $673.00 | 1235677808 - ATHENS ORTHOPEDIC CLINIC AMBULATORY SURGERY CENTER-LOGANVILLE, LLC | 812389963 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $370.00 | 1548263619 - AZAR EYE SURGERY CENTER LLC | 522325381 - (MD) AZAR EYE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59130 | $17689.00 | 1821614710 - BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC, KAUKAUNA SURGERY CENTER | 851420464 - (WI) BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 59130 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59130 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 59130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 59100-CPT | High | Hysterotmy,Abd Eg,For Hydatidiform Mole |
| 59120-CPT | Moderate | Surgical Treatment Of Ectopic Pregnancy; Tubal Or Ovarian, Requiring Salpingectomy And/Or Oophorectomy, Abdominal Or Vaginal Approach |
| 59121-CPT | Moderate | Treatment Tubal Pregnancy |
| 59130-CPT | High | Surg.Tx-Ectopic Pregnancy;Abd Preg. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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