2025 CPT code 59514
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures for Maternity Care and Delivery Surgery Feed
Cesarean delivery only; performed when vaginal delivery is not possible or safe.
Modifier 22 (Increased procedural service) can be applied if the Cesarean delivery involves significantly more work than usual.Modifier 59 (Distinct procedural service) may apply under certain circumstances, but careful documentation is required to support use.
Medical necessity is established by a clinical indication for a Cesarean delivery. This might be due to maternal or fetal risk factors such as failed vaginal delivery attempt, fetal distress, malpresentation, or medical conditions affecting the mother.
The physician is responsible for the entire intrapartum management of the Cesarean delivery, including initial assessment, monitoring, surgical procedure, and immediate postpartum care. This might involve communication and coordination with other healthcare professionals (anesthesia, nursing, pediatrics).
In simple words: This code covers a C-section (Cesarean section) birth, where the baby is delivered through a cut in the mother's belly. It only includes the surgery and immediate care afterward, not the care before or after the birth date.
This CPT code encompasses the surgical delivery of a fetus and placenta via an abdominal incision.The procedure includes admission to the hospital, initial history and physical examination, management of the Cesarean delivery, and immediate postpartum care on the same date of service.Antepartum care and postpartum care beyond the delivery date are excluded.The code applies to both planned and emergency Cesarean deliveries when vaginal delivery is not feasible or poses risks to the mother or child.This includes scenarios where labor fails, but there is no history of previous Cesarean sections. The provider manages labor if it begins before the planned Cesarean delivery.
Example 1: A patient presents to the hospital in labor, which fails to progress. After a thorough assessment, the physician determines a Cesarean delivery is necessary and proceeds with the surgery, using code 59514., A patient has a scheduled Cesarean section due to a previous Cesarean section, breech presentation, or other maternal/fetal indication. Code 59514 is used to bill for this planned Cesarean delivery., A patient experiences a complication during labor (e.g., fetal distress) necessitating an emergency Cesarean delivery.The physician performs the surgery and utilizes code 59514.
Detailed documentation of the reason for Cesarean delivery, including the patient's history and physical examination findings, fetal monitoring records (if applicable), labor progression notes (if applicable), description of the surgical procedure performed, and immediate postoperative care provided are necessary.
** The code 59514 specifically excludes antepartum and postpartum care.Separate codes should be used for those services.Accurate documentation is crucial to support the use of this code and to avoid potential audit issues.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Information not available in provided text.Consult current RVU data for accurate values.
- Global Days : Information not available in provided text.Consult current CPT guidelines for global surgical period details.
- Payment Status: Active
- Modifier TC rule: Information not available. Consult current CPT guidelines for modifier TC rules.
- Fee Schedule : Information not available in provided text.Consult historical fee schedule data for relevant information.
- Specialties:Obstetrics and Gynecology
- Place of Service:Inpatient Hospital