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CPT 59618: Repeat Cesarean Delivery After Failed Trial of Labor
CPT code 59618 represents a full global obstetric service for patients who undergo a repeat cesarean delivery following a failed trial of labor after a prior cesarean. This code bundles antepartum care, hospital admission and intensive intrapartum management, cesarean delivery via abdominal incision, and routine inpatient and outpatient postpartum visits. It is widely used in national billing for managing labor complications related to prior cesarean delivery and captures the comprehensive care pathway from early pregnancy through the postpartum period.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find national context on the clinical scope of the code, comparisons to closely related obstetric codes, and operational details that affect billing and documentation for repeat cesarean deliveries after attempted vaginal birth. The publication also outlines common clinical scenarios tied to the code, typical sites of service, and how this global service differs from codes for routine vaginal delivery or cesarean delivery-only services.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a concise reference on CPT code 59618, clarifying what the code covers and how it fits within obstetric service lines and coding workflows.
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Billing Code Overview
CPT code 59618 describes a global obstetric service for a patient who attempts a vaginal delivery after a previous cesarean delivery but ultimately requires a repeat cesarean delivery. The global service includes all antepartum care, admission to the hospital for delivery, intensive management of labor, performance of a cesarean delivery via abdominal incision (including delivery of the fetus and placenta), and postpartum care provided in both the inpatient and outpatient settings.
Service type: Comprehensive obstetric global service covering antepartum, intrapartum (cesarean delivery after attempted vaginal birth after cesarean), and postpartum care.
Typical site of service: Outpatient obstetric clinics for antepartum care, inpatient hospital setting for admission and cesarean delivery, and outpatient clinics or office visits for postpartum follow-up.
National Reimbursement Benchmarks
Medicare's mean allowed amount for CPT 59618 sits at $2,506, which is meaningfully below BUCA's average commercial mean of $3,193.80. That $687.80 gap highlights that commercial arrangements captured by BUCA are, on average, substantially higher than Medicare levels for this code, with Medicare concentrated around a narrower central tendency (P25 $2,393, P50 $2,459, P75 $2,618) compared with BUCA's broader commercial spread (P25 $2,077.80, P50 $2,951.70, P75 $3,949.30). These differences underscore a notable gulf between public program pricing and commercial reimbursement norms.
Dispersion measured as P75 minus P25 varies across payers: Blue Cross Blue Shield shows a tight interquartile range of $1,386.90, while Aetna's IQR is $2,053.00 and Cigna's is $2,637.80. UnitedHealth Group and BUCA exhibit the widest spreads at $2,331.20 and $1,871.50 respectively. In this context, Blue Cross Blue Shield appears most compressed around its central values; Cigna and UnitedHealth Group demonstrate the greatest price variability within the middle 50% of their distributions.