Summary & Overview
CPT 59855: Second-Trimester Termination by Induction and Laminaria
CPT code 59855 covers inpatient termination of pregnancy performed after 14 weeks’ gestation using labor induction with vaginal suppositories, often combined with insertion of a laminaria for cervical dilation. The admitting provider manages the induction, labor, delivery of the fetus and placenta, and inpatient follow-up until discharge. Nationally, this procedure represents a distinct obstetric surgical service with implications for inpatient utilization, facility resource needs, and clinical pathways for later-gestation pregnancy termination.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 59855, common billing and service considerations, and what to expect in payer coverage patterns and coding practice. The publication summarizes benchmarks where available, notes policy or reimbursement updates that affect inpatient obstetric procedures, and clarifies typical sites of service and service lines relevant to hospital billing teams.
This briefing is intended for hospital billing managers, OB/GYN clinicians involved in procedural care, revenue cycle professionals, and policy analysts seeking a national perspective on coding and operational implications for second-trimester pregnancy termination by induction.
Billing Code Overview
CPT code 59855 describes a termination of pregnancy after the first trimester by inducing labor with vaginal suppositories and may include insertion of a laminaria for cervical dilation. The provider admits the patient to the hospital, inserts the medication and cervical dilator, manages the ensuing labor, delivers the fetus and placenta, and follows the patient during the inpatient stay until discharge.
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Service type: Inpatient obstetric procedure for second-trimester pregnancy termination using labor induction and possible cervical dilation with laminaria.
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Typical site of service: Hospital inpatient setting.
Clinical & Coding Specifications
Clinical Context
A 28-year-old woman at 18 weeks and 3 days gestation presents to the hospital requesting pregnancy termination for fetal anomaly confirmed on ultrasound. After informed consent and pre-procedure evaluation, the provider admits the patient to an inpatient obstetric unit. The clinician places cervical dilators (for example, laminaria or osmotic dilators) and inserts vaginal prostaglandin suppositories to induce contractions. The team provides analgesia, monitors maternal vital signs and fetal heart status as indicated, and manages labor progression. When the fetus and placenta are delivered, the provider performs any necessary uterine evacuation maneuvers and postpartum assessment, orders and documents any pathology or specimen handling, and continues inpatient follow-up until the patient meets discharge criteria. Typical documentation includes admission history and indication, informed consent, details of dilator and medication insertion, labor management notes, delivery note, postpartum orders, and discharge summary. Typical site of service is an inpatient hospital labor and delivery unit or an ambulatory surgical center with inpatient admission capability for later-gestation procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard single procedure indicator (placeholder) | Use per payer-specific instructions when required to indicate an unmodified primary procedure code. |