CPT 59409: Hospital Admission for Vaginal Delivery with Labor Management
Medicare pays $721 and commercial payers pay $2187 on average nationally for this procedure.
CPT code 59409 describes hospital admission for delivery with labor management (including induction and fetal monitoring), performance of low forceps and episiotomy as needed, and vaginal delivery of the fetus and placenta on the same date of service; service type: inpatient obstetric delivery and labor management; typical site of service: hospital labor and delivery unit.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Medicare’s mean rate for CPT 59409 is $720.50, substantially lower than BUCA’s average commercial mean of $2,186.60, highlighting a roughly $1,466 difference between government and BUCA-level commercial reimbursement. This gap reflects typical Medicare compression versus commercial negotiated levels and positions BUCA near the top of commercial averages for this code.
Dispersion analysis (P75 minus P25) shows Blue Cross Blue Shield with the widest interquartile spread at $2,001.90 ($3,752.50 - $1,750.60), indicating high variability in contracted rates. UnitedHealth Group and BUCA follow with spreads of $784.00 ($1,635.90 - $885.10) and $1,494.90 ($2,791.60 - $1,297.10) respectively. Aetna and Cigna present the tightest dispersion at $895.60 ($1,279.20 - $402.40) for Aetna and $808.60 ($1,616.30 - $789.70) for Cigna, suggesting more clustered commercial pricing among those payers.