CPT 59866 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 52 - Reduced Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 59866 |
National average reimbursement for CPT 59866 by major payers:
$292.49
$314.36
$329.42
$373.39
| 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 59866 | ||||||
United | 59866 | $566.00 | 1154387710 - WARNER PARK SURGERY CENTER LLC, CENTER FOR ADVANCED SURGERY | 752824260 - (AZ) WARNER PARK SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $123.00 | 1053031237 - FRESENIUS VASCULAR CARE EL PASO ASC LLC | 861628275 - (TX) FRESENIUS VASCULAR CARE EL PASO ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $211.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $1446.00 | 1275536328 - BELLAIRE OUTPATIENT SURGERY CENTER, LLP, BAYLOR SCOTT & WHITE SURGICARE - OAKMONT | 562297308 - (TX) BELLAIRE OUTPATIENT SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $106.00 | 1104835776 - CENTRAL OHIO GASTROENTEROLOGY ASSOCIATES,LLC, MID OHIO SURGERY CENTER | 204751805 - (OH) CENTRAL OHIO GASTROENTEROLOGY ASSOCIATESLLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $555.00 | 1659517019 - SURGERY CENTER OF PEMBROKE PINES, LLC | 263364068 - (FL) SURGERY CENTER OF PEMBROKE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $79.00 | 1902213432 - COBBLESTONE SURGERY CENTER, INC. | 464241477 - (GA) COBBLESTONE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $176.00 | 1033141825 - GREENSPRING SURGERY CENTER LLC | 203320836 - (MD) GREENSPRING SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $115.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $81.00 | 1508879446 - WEST FLORIDA SURGERY CENTER INC | 651092124 - (FL) WEST FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $200.00 | 1780322750 - QUEENSRIDGE SURGERY CENTER | 862358950 - (NV) QUEENSRIDGE SURGERY CENTER | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $546.00 | 1972565745 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE SURGERY CENTER AT RAINIER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $566.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $44.00 | 1538109384 - PLASTIC SURGERY SPECIALISTS, PC | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59866 | $618.00 | 1316317134 - SUMMER STREET ASC LLC | 474990107 - (CT) SUMMER STREET ASC LLC | CT | 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 59866 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59866 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 59866 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 |
|---|---|---|
| 59866-CPT | Moderate | Multifetal Pregnancy Reduction(S) (Mpr) |
| 59870-CPT | Moderate | Uterine Evac/Curet-Hydatidifrm Mole |
| 59871-CPT | Low | Removal Of Cerclage Suture Under Anesthesia (Other Than Local) |
| 59897-CPT | High | Unlisted Fetal Invasive Procedure, Including Ultrasound Guidance, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59866. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59866 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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