CPT 59612
Global MMM ActiveVbac delivery only
CPT 59612 Billing & Documentation Guide
CPT code 59612 (Vbac delivery only) is classified under Surgery (Urinary/Reproductive) with a global period indicator of MMM. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 16.09, a non-facility practice expense RVU of 3.41, and a malpractice RVU of 5.15, a total non-facility RVU of 24.65 and facility RVU of 24.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $814.5, though rates vary from $699.51 to $1091.01 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59612, 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 59612 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 59612 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 59612
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 16.09 | 16.09 |
| Practice Expense RVU | 3.41 | 3.41 |
| Malpractice RVU | 5.15 | 5.15 |
| Total RVU | 24.65 | 24.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59612
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 | $784.74 | $784.74 | $763.59 - $852.98 | 29 |
| Florida | $986.55 | $986.55 | $904.84 - $1091.01 | 3 |
| Georgia | $852.7 | $852.7 | $844.06 - $861.34 | 2 |
| Illinois | $978.07 | $978.07 | $910.27 - $1050.42 | 4 |
| Michigan | $886.48 | $886.48 | $835.61 - $937.35 | 2 |
| North Carolina | $753.6 | $753.6 | $753.6 - $753.6 | 1 |
| New York | $923.83 | $923.83 | $766.55 - $1026.67 | 5 |
| Ohio | $814.8 | $814.8 | $814.8 - $814.8 | 1 |
| Pennsylvania | $837.7 | $837.7 | $804.53 - $870.87 | 2 |
| Texas | $812.29 | $812.29 | $788.76 - $891.51 | 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 59612
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59612 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 59612
What does CPT code 59612 mean? +
CPT code 59612 represents: Vbac delivery only. It's in the Surgery (Urinary/Reproductive) category with a global period of MMM.
What is the Medicare reimbursement for CPT 59612? +
The 2026 Medicare national average non-facility payment for CPT 59612 is $814.5. Rates range from $699.51 to $1091.01 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59612? +
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 59612? +
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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