CPT 59897 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • UA |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 59897 |
National average reimbursement for CPT 59897 by major payers:
$1,106.30
$593.57
$1,891.35
$2,586.22
| 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 59897 | ||||||
United | 59897 | $140.00 | 1396123865 - SOUND SURGEONS PLLC, NORTHWEST WEIGHT LOSS SURGERY | 461190829 - (WA) SOUND SURGEONS, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $1875.00 | 1710931860 - GRASS VALLEY SURGERY CENTER, LLC | 272185264 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $85.00 | 1760658256 - HARVARD SURGERY CENTER LLC | 208147301 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $325.00 | 1306135298 - DMG PAIN MANAGEMENT SURGERY CENTER, LLC | 271322187 - (IL) DMG PAIN MANAGEMENT SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $574.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $86.00 | 1306214705 - GSI ASC, LLC | 474883816 - (OK) GSI ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $175.00 | 1225414246 - LV SURGERY CENTER LLC | 473021380 - (NV) LV SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $342.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $179.00 | 1134363690 - OAM SURGERY CENTER AT MIDTOWNE, LLC, METRO HEALTH OAM SURGERY CENTER | 261805066 - (MI) OAM SURGERY CENTER AT MIDTOWNE LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $200.00 | 1831182799 - ZION EYE INSTITUTE, INC | 841432944 - (UT) ZION EYE INSTITUTE INC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $300.00 | 1952540825 - ROME ORTHOPAEDIC CLINIC ASC, INC. | 261595646 - (GA) ROME ORTHOPAEDIC CLINIC ASC INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $555.00 | 1790252864 - TREASURE COAST ASC, LLC, TREASURE COAST CENTER FOR SURGERY | 384092821 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $850.00 | 1043679509 - NORTHPOINTE SURGICAL SUITES, LLC | 472788542 - (OH) NORTHPOINTE SURGICAL SUITES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $1446.00 | 1992721591 - DAY SURGERY CENTER OF NORTH TEXAS LTD | 260308454 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $96.00 | 1851845986 - WEST SHORE PAIN AND SPINE INSTITUTE, LLC | 812668532 - (PA) WEST SHORE PAIN AND SPINE INSTITUTE LLC | PA | 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 59897 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59897 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 59897 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 59897. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59897 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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