CPT 59409
Global MMM ActiveObstetrical care
CPT 59409 Billing & Documentation Guide
CPT code 59409 (Obstetrical care) is classified under Surgery (Urinary/Reproductive) with a global period indicator of MMM. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 14.37, a non-facility practice expense RVU of 3.22, and a malpractice RVU of 4.02, a total non-facility RVU of 21.61 and facility RVU of 21.61. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $716.95, though rates vary from $624.36 to $931.5 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59409, 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 59409 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Maternity codes (separate billing rules)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 59409 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 59409
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 14.37 | 14.37 |
| Practice Expense RVU | 3.22 | 3.22 |
| Malpractice RVU | 4.02 | 4.02 |
| Total RVU | 21.61 | 21.61 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59409
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 | $697.25 | $697.25 | $677.98 - $759.83 | 29 |
| Florida | $849.26 | $849.26 | $784.6 - $931.5 | 3 |
| Georgia | $743.95 | $743.95 | $735.96 - $751.94 | 2 |
| Illinois | $842.16 | $842.16 | $788.03 - $899.57 | 4 |
| Michigan | $769.95 | $769.95 | $729.76 - $810.14 | 2 |
| North Carolina | $666.12 | $666.12 | $666.12 - $666.12 | 1 |
| New York | $805.26 | $805.26 | $676.54 - $887.91 | 5 |
| Ohio | $713.51 | $713.51 | $713.51 - $713.51 | 1 |
| Pennsylvania | $733.18 | $733.18 | $705.59 - $760.76 | 2 |
| Texas | $713.22 | $713.22 | $695.13 - $775.37 | 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 59409
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59409 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0021T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 01958 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01960 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01967 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 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 |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 59409
What does CPT code 59409 mean? +
CPT code 59409 represents: Obstetrical care. It's in the Surgery (Urinary/Reproductive) category with a global period of MMM.
What is the Medicare reimbursement for CPT 59409? +
The 2026 Medicare national average non-facility payment for CPT 59409 is $716.95. Rates range from $624.36 to $931.5 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59409? +
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 59409? +
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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