CPT 59000
Global 000 ActiveAmniocentesis diagnostic
CPT 59000 Billing & Documentation Guide
CPT code 59000 (Amniocentesis diagnostic) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.27, a non-facility practice expense RVU of 1.9, and a malpractice RVU of 0.41, a total non-facility RVU of 3.58 and facility RVU of 2.18. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $121.24, though rates vary from $103.99 to $146.02 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59000, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 59000 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 59000 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 59000
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.27 | 1.27 |
| Practice Expense RVU | 1.9 | 0.5 |
| Malpractice RVU | 0.41 | 0.41 |
| Total RVU | 3.58 | 2.18 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59000
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $126.46 | $71.13 | $120.03 - $145.94 | 29 |
| Florida | $132.75 | $85.84 | $123.67 - $143.12 | 3 |
| Georgia | $119.41 | $74.8 | $115.35 - $123.47 | 2 |
| Illinois | $130.05 | $84.87 | $121.76 - $137.92 | 4 |
| Michigan | $121.29 | $77.38 | $115.82 - $126.75 | 2 |
| North Carolina | $110.38 | $66.75 | $110.38 - $110.38 | 1 |
| New York | $133.85 | $81.68 | $112.33 - $146.02 | 5 |
| Ohio | $114.16 | $71.47 | $114.16 - $114.16 | 1 |
| Pennsylvania | $119.6 | $73.8 | $113.62 - $125.58 | 2 |
| Texas | $117.85 | $71.82 | $112.89 - $124.62 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 59000
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59000 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 59000
What does CPT code 59000 mean? +
CPT code 59000 represents: Amniocentesis diagnostic. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 59000? +
The 2026 Medicare national average non-facility payment for CPT 59000 is $121.24. Rates range from $103.99 to $146.02 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59000? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 59000? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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