CPT 59400 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 • 11 - Office |
| Common Modifiers | • None • U9 • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 59400 |
National average reimbursement for CPT 59400 by major payers:
$2,621.34
$2,677.83
$2,908.78
$3,616.25
| 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 59400 | ||||||
United | 59400 | $1800.00 | 1578663167 - TAMMY VU | 742068804 - (TX) EAST HOUSTON OBGYN ASSOCIATES | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $7318.51 | 1760197883 - HODAYA LIGHTSTONE | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Acute Care Nurse Practitioner (363LA2100X) |
United | 59400 | $4382.88 | 1194763011 - JACOB WALFISH | 135562308 - NEW YORK UNIVERSITY | NY | Gastroenterology Physician (207RG0100X) |
United | 59400 | $7318.51 | 1366447971 - SCOTT GOTTESFELD | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 59400 | $4038.43 | 1164623500 - ORIT OPPENHEIMER | 133956599 - BOSTON CHILDREN'S HEALTH PHYSICIANS, LLP | NY | Pediatrics Physician (208000000X) |
United | 59400 | $1800.00 | 1114998176 - TIMOTHY JONES | 710892430 - (TX) TEXAS HEALTH CARE, P.L.L.C. | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $1344.00 | 1942397104 - PREMIER ENDOSCOPY, LLC | 50599351 - (NJ) PREMIER ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59400 | $1400.00 | 1659807717 - TAMPA SURGICAL CENTER LLC | 820715188 - (CA) TAMPA SURGICAL CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59400 | $2760.03 | 1154409167 - JOCELYN GREELY | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $6792.07 | 1982163317 - ISABEL SALAMONE | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Adult Health Nurse Practitioner (363LA2200X) |
United | 59400 | $7318.51 | 1306320080 - TANYA THAKUR | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Physician Assistant (363A00000X) |
United | 59400 | $2365.73 | 1689195992 - GPCH, LLC, GOLDEN PLAINS SPECIALTY CLINIC | 260328929 - (TX) GPCH,LLC DBA GOLDEN PLAINS COMMUNITY HOSPITAL | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $1800.00 | 1962525899 - MONIQUE MCKNIGHT | 260834681 - (TX) TEXAS CHILDRENS PHYSICIAN GROUP | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $5264.39 | 1609908078 - ADRIENNE PERFILIO EDWARDS | 470765154 - ALEGENT CREIGHTON CLINIC | NE | Obstetrics & Gynecology Physician (207V00000X) |
United | 59400 | $3084.34 | 1992065593 - SUNNIYA KHAN | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NJ | Pain Medicine Physician (208VP0000X) |
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 59400 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59400 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 59400 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 |
|---|---|---|
| 59400-CPT | High | Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (With Or Without Episiotomy, And/Or Forceps) And Postpartum Care |
| 59409-CPT | High | Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps) |
| 59410-CPT | High | Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps) Including Postpartum Care |
| 59412-CPT | Low | External Cephalic Version, With Or Without Tocolysis (List In Addition To Code(S) For Delivery) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59400 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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