Summary & Overview

HCPCS G9355: Elective Delivery Not Performed Before 39 Weeks

Headline: HCPCS Level II code G9355 flags elective pre-39-week deliveries that are not performed

Lead: HCPCS Level II code G9355 denotes an elective cesarean delivery or induction of labor set to occur before 39 weeks of gestation that ultimately is not performed. The code provides a standardized way to record instances where planned elective early delivery without medical indication is cancelled or deferred. It matters nationally because efforts to reduce elective early-term deliveries are linked to improved neonatal outcomes and payer quality programs.

This publication covers common national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, the typical service setting, and what documentation elements are relevant for claims and quality measurement. The report summarizes available benchmarks and policy implications at a national level and highlights clinical context around timing of delivery decisions and potential quality measure alignment.

What readers will learn: an overview of the code’s purpose, how it fits into maternal-fetal care workflows in hospital labor and delivery settings, the typical payers that recognize the code, and where to find further reference materials. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9355HCPCS Level IIelective deliverypreterm deliverycesarean deliverylabor inductionmaternal healthquality measurementhospital inpatient

Billing Code Overview

HCPCS Level II code G9355 describes elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation). This code applies when a scheduled cesarean delivery or labor induction that would result in delivery before 39 weeks of gestation is not performed because the delivery is elective and lacks a medical indication.

Service type: Maternal delivery services related to elective preterm cesarean or induction decisions
Typical site of service: Hospital inpatient or labor and delivery setting

Clinical & Coding Specifications

Clinical Context

A 32-year-old G2P1 at 38 weeks and 4 days gestation requests an elective repeat cesarean delivery without medical indication. Prenatal testing is unremarkable, fetal growth is appropriate, and maternal vital signs and labs are within normal limits. The obstetric clinic documents counseling about risks of delivery prior to 39 weeks, neonatal respiratory immaturity, and alternatives including scheduled cesarean at ≥39 weeks or spontaneous labor. The patient opts for elective cesarean before 39 weeks for nonmedical reasons; the procedure is scheduled and performed in the hospital operating room with standard maternal and neonatal perioperative care.

The clinical workflow includes preoperative evaluation by obstetrics, anesthesia pre-op assessment, informed consent documenting elective nature of delivery and absence of medical indication, scheduling of the operating room, intraoperative cesarean delivery by the obstetric surgeon with anesthesiology support, immediate neonatal assessment by pediatric team, and standard postpartum monitoring. Billing staff assign HCPCS Level II code G9355 to indicate an elective delivery by cesarean or induction not performed prior to 39 weeks when the delivery is without medical indication, and attach appropriate modifiers reflecting circumstances (for example, anesthesia modifiers or modifiers for unusual procedural complexity).

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or complexity for the procedure is substantially greater than typically required.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary and is not typically used for the procedure.
`52`	Reduced services	Use when the service performed was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances or those threatening patient well‑being.
`54`	Surgical care only	Use when only the surgical portion is billed and pre/postoperative care is billed separately.
`55`	Postoperative management only	Use when only postoperative care is billed by a provider other than the surgeon.
`56`	Preoperative management only	Use when only preoperative evaluation and management are billed by a provider other than the surgeon.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons due to complexity.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an assistant-at-surgery from these provider types participates and payer accepts the modifier.
`CO`	Procedural service related to worker's compensation	Use when the service is related to a worker's compensation payment/claim.

Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	Primary specialty performing cesarean deliveries and management of labor and delivery.
`207L00000X`	Anesthesiology	Provides regional or general anesthesia for cesarean delivery and perioperative care.
`208000000X`	Pediatrics	Provides neonatal resuscitation and newborn assessment in the delivery suite.
`364S00000X`	Certified Registered Nurse Anesthetist (CRNA)	Provides anesthesia services in settings where authorized; may use `AS` modifier when assisting.
`231Z00000X`	Family Medicine	May perform obstetric deliveries including cesarean coordination in some practice settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O80`	Encounter for full-term uncomplicated delivery	Represents term uncomplicated delivery; relevant as baseline comparison when elective early delivery is performed without medical indication.
`O82`	Encounter for cesarean delivery, not elsewhere classified	Used to report cesarean delivery when performed; applicable to billing surgical delivery services.
`O42.01`	Premature rupture of membranes, onset of labor within 24 hours, second trimester (placeholder)	Not typically used for elective delivery; Data not available in the input.
`Z37.0`	Single live birth	Describes outcome and is commonly reported on maternity records and claims.
`Z3A.38`	38 weeks gestation of pregnancy	Captures gestational age; relevant for documenting gestational age <39 weeks when using `G9355`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`59510`	Routine obstetric care including antepartum care, cesarean delivery, and postpartum care	Primary global obstetric code when cesarean delivery is performed; often billed for the obstetrician's global maternity care including the cesarean.
`59618`	Routine obstetric care including antepartum care, cesarean delivery, and postpartum care following attempted vaginal delivery after previous cesarean	Used when the cesarean follows a trial of labor after prior cesarean; not generally used for an elective repeat without trial.
`59409`	Vaginal delivery (with or without episiotomy and/or forceps) including postpartum care	Listed for context when induction or attempted vaginal delivery is relevant; not used for cesarean delivery billing.
`01961`	Anesthesia for cesarean delivery when administered with regional technique	Billed by anesthesia providers for anesthesia services during cesarean delivery; relates to perioperative billing alongside the surgical code.
`58150`	Closure of hysterotomy (included in cesarean) — listed here for surgical detail context	Surgical component related to cesarean technique and operative reporting; typically included in the primary cesarean code.