CPT 59400: Vaginal Delivery, Global Package
59400 reports a whole pregnancy episode in one code: routine antepartum care, a vaginal delivery and postpartum care, all by the same physician or group. The fee schedule gives it a global period of MMM, and prenatal visits, fetal monitoring, episiotomy and placental delivery are not billed on top of it.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 59400 is the global package for a vaginal delivery with antepartum and postpartum care, billed once on one claim line. It carries status A and a global period of MMM in the October 2026 fee schedule file. Ultrasound, amniocentesis, genetic screening and unrelated visits are billed separately.
What Does CPT 59400 Report?
59400 reports total obstetric care for a vaginal delivery: the routine antepartum care, the delivery and the postpartum care, billed as one package by the group that provided all three. NCCI Policy Manual Chapter VII, section G.1, says the total obstetrical packages, such as 59400 and 59510, include antepartum care, the delivery and postpartum care.
| Item | Value |
|---|---|
| Payment status | A (active, paid under the fee schedule if covered) |
| Global period | MMM (maternity; the usual global period does not apply) |
| Work RVU | 37.00 |
| Total RVU | 66.30 in both settings |
| Non-facility NA indicator | NA (rarely or never performed in the non-facility setting) |
| Multiple procedure indicator | 2 |
| Assistant at surgery | 1 (statutory restriction; may not be paid) |
| Co-surgeons and team surgery | 0 (not permitted) |
| Practitioner MUE, Q4 2026 | 1 per date, indicator 2, rationale code descriptor |
An MAI of 2 is an absolute per-day edit based on policy (NCCI Chapter I). A second unit of 59400 for one pregnancy is not a correction you can win on appeal.
What Is Inside the Package, and What Is Billed on Top?
The package pays for the visits, the delivery and the aftercare, so each of those is not a claim line of its own. Chapter VII, section G.2, names fetal monitoring 59050 and 59051, episiotomy 59300 and delivery of the placenta 59414 as included and not separately reportable, and section G.3 says antepartum urinalysis is not separately reportable.
Chapter VII, section I, adds that wound repair codes 12001 to 13153 are not reported to close a surgical incision for an MMM code.
The same manual says what the package leaves out: ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions incidental to pregnancy and additional frequent visits due to high-risk conditions. A scan has its own page at 76805. Our OB/GYN billing page shows how those pieces fit on one claim.
When Should You Use 59400 and When a Split Code?
Use 59400 only when your group provided all three parts; otherwise bill the part you did. Chapter VII names the delivery codes 59409 for vaginal delivery only and 59410 for vaginal delivery with postpartum care, and the fee schedule file lists the antepartum and postpartum codes next to them.
| Code | What the group provided | Work RVU |
|---|---|---|
| 59400 | Antepartum care, vaginal delivery and postpartum care | 37.00 |
| 59410 | Vaginal delivery and postpartum care | 18.76 |
| 59409 | Vaginal delivery only | 14.37 |
| 59426 | Antepartum care only, the higher-priced code | 14.30 |
| 59425 | Antepartum care only, the lower-priced code | 7.80 |
| 59430 | Care after delivery only | 3.22 |
Chapter 12, section 100.1.6, notes that global obstetric codes can name a minimum number of visits in the descriptor, and that a teaching physician must be present for the delivery to bill the package. If the teaching physician was involved only at the delivery, the delivery-only code applies.
Section 130.2 says that when a nurse-midwife gives most of the care and a physician gives part, the nurse-midwife's fee is based on the portion of the global fee the physician would have been paid, reported with reduced service modifiers.
How Does 59400 Sit on the Claim?
Put it on one CMS-1500 line with 1 unit. Item 24G requires the numeral 1 when one service is performed (chapter 26).
Because the assistant-at-surgery indicator is 1, an assistant at surgery is not paid for 59400, and the co-surgeon and team indicators of 0 do not permit those claims. The anesthesia code for a vaginal delivery, 01960, has status J in the file, meaning no RVUs, and is billed by the anesthesia provider; see anesthesia billing.
When the pregnancy is unusually difficult, many payers want modifier 22 with documentation. Whether yours does is set by the payer's own policy.
What Fields Carry the Full Obstetric Package?
The package is one line, 59400 in Item 24D with 1 unit in Item 24G and the date of delivery in Item 24A. Item 24E points to the delivery or pregnancy diagnosis. RVU26D shows the global indicator MMM, which the file defines as maternity codes where the usual global period does not apply.
The MUE table allows 1 per date with indicator 2.
Example: A patient has prenatal care, a vaginal delivery on 10/09 and a postpartum visit, all with the same group. The line is 59400, pointer A (O80), 1 unit, $3,600.00, dated 10/09. If the group billed prenatal visits earlier and also 59400, the payer would see duplicate care and may deny under CO-97.
Why Does a 59400 Claim Deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 97 with RARC M144 | Benefit included in the allowance for another service already adjudicated; M144: pre-/post-operative care payment is included in the allowance for the surgery/procedure | Prenatal or postpartum visits billed on top of the package |
| 97 with RARC N19 | Benefit included in another service; N19: procedure code incidental to primary procedure | Fetal monitoring, episiotomy or placenta delivery billed separately |
| 18 | Exact duplicate claim/service (use only with group code OA except where state workers' compensation regulations require CO) | Two groups both billing the package for one pregnancy |
| 11 | The diagnosis is inconsistent with the procedure | A delivery code with no pregnancy diagnosis on the line |
If these denials keep coming back, our denial management team can work them. Bundling denials on package claims are covered under CO-97.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- 2026 NCCI Medicare Policy Manual, Chapter VII: Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
- Remittance Advice Remark Codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does the global package 59400 include?
Antepartum care, a vaginal delivery and postpartum care. NCCI Chapter VII also makes fetal monitoring 59050 and 59051, episiotomy 59300, delivery of the placenta 59414 and antepartum urinalysis not separately reportable. Ultrasound, amniocentesis, genetic screening, unrelated visits and extra high-risk visits are outside it.
02Can I bill prenatal visits on top of 59400?
Not routine ones. They are part of the package, and a payer will return CARC 97 with a remark that pre- or postoperative care is included. Visits for conditions unrelated to the pregnancy, and extra frequent visits caused by a high-risk condition, are outside the package under the NCCI manual.
03What global period does 59400 have?
The October 2026 fee schedule file gives 59400 a global period of MMM, meaning maternity codes, where the usual global period does not apply. NCCI Chapter VII, section G.4, says these procedures are subject to the global surgery and anesthesia rules.
04How many units of 59400 can be billed?
One. The practitioner MUE for the fourth quarter of 2026 is 1 per date with indicator 2, which is an absolute edit based on policy. Billing the package twice for one pregnancy also produces a duplicate denial from the payer.
05Can an assistant surgeon bill with 59400?
Not for Medicare. The assistant-at-surgery indicator for 59400 is 1 in the October 2026 file, which means a statutory payment restriction applies and an assistant at surgery may not be paid. Co-surgeons and surgical teams are also not permitted, indicator 0.
06Can I bill 59400 if a teaching physician only attended the delivery?
No. Chapter 12, section 100.1.6, says that when the teaching physician's only involvement was at delivery, the delivery-only code is billed. To bill the global code the teaching physician must be present for the minimum number of visits the code specifies.
Global OB Claims Denied as Bundled?
We check each pregnancy for package versus split billing before the claim is sent.