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 |
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 | $574.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $209.00 | 1174258107 - FW SPECIALTY SURGICARE, LLC | 854261198 - (TX) FW SPECIALTY SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $125.00 | 1831413772 - OXFORD UROCARE PLLC | 272032475 - (MS) OXFORD UROCARE PLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $1551.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | 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 | $2202.00 | 1346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN | 471353602 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $112.00 | 1932212511 - PALESTINE LASER & SURGERY CENTER PLLC | 470900270 - (TX) PALESTINE LASER SURGERY CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $555.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | 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 | $366.00 | 1073758298 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT GALLOWAY NORTH | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $907.00 | 1477503175 - PALMS WEST SURGERY CENTER LTD | 201008459 - (FL) PALMS WEST SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $110.00 | 1073546875 - STRAND GASTROINTESTINAL ENDOSCOPY CENTER | 571082826 - (SC) STRAND GASTROINTESTINAL ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $1344.00 | 1831275775 - NORTH JERSEY GASTROENTEROLOGY & ENDOSCOPY CENTER P.A. | 223637494 - (NJ) NORTH JERSEY GASTROENTEROLOGY ENDOSCOPY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $399.00 | 1568437820 - FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC, FLORIDA ENDOSCOPY & SURGERY CENTER | 593622500 - (FL) FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 59897 | $803.00 | 1386647527 - ORTHOPEDIC SURGERY CENTER OF OC LLC | 330841806 | CA | 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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