CPT code 59409: Vaginal delivery, delivery only2026 Medicare rate & RVUs in Puerto Rico
Vaginal delivery service, with or without episiotomy or forceps, reported when the clinician performs delivery but does not provide postpartum care.
In Puerto Rico, Medicare pays $720.96 for 59409 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 59409 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 59409 covers
This code represents the clinician’s work for a vaginal birth, whether spontaneous or assisted with forceps, and includes an episiotomy when performed. Obstetricians and other qualified clinicians report it for the delivery encounter, commonly in a hospital or other delivery setting; it is the delivery-only option rather than a package that also captures antepartum or postpartum care.
Select 59409 when the billed clinician’s service is the vaginal delivery and not the related antepartum/postpartum package. The record should support the vaginal birth and delivery services provided, including any forceps or episiotomy. Routine global surgery rules do not apply to this maternity code. If other procedures are performed in the same session, CMS pays the highest-valued procedure in full and reduces the others to 50% under the standard multiple-procedure rule.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 59409
Across 109 of 109 payment localities, the facility rate for 59409 runs from $624.36 in Wisconsin to $931.50 in Miami, FL. Puerto Rico pays $720.96. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$720.96
- Los Angeles, CA · California$716.04−$4.92
- Washington, DC area · District of Columbia$782.03+$61.07
- Miami, FL · Florida$931.50+$210.54
- Chicago, IL · Illinois$899.57+$178.61
- Manhattan, NY · New York$848.62+$127.66
- Alaska · Alaska$908.48+$187.52
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $650.08 |
| ArkansasArkansas | — | $641.51 |
| ArizonaArizona | — | $699.12 |
| Bakersfield, CACalifornia | — | $688.74 |
| Chico, CACalifornia | — | $677.98 |
| El Centro, CACalifornia | — | $678.65 |
| Fresno, CACalifornia | — | $677.98 |
| Hanford, CACalifornia | — | $677.98 |
| Madera, CACalifornia | — | $677.98 |
| Merced, CACalifornia | — | $677.98 |
| Modesto, CACalifornia | — | $677.98 |
| Napa, CACalifornia | — | $720.17 |
| Oxnard, CACalifornia | — | $704.19 |
| Redding, CACalifornia | — | $677.98 |
| Rest of CaliforniaCalifornia | — | $677.98 |
| Riverside, CACalifornia | — | $721.02 |
| Sacramento, CACalifornia | — | $694.30 |
| Salinas, CACalifornia | — | $691.47 |
| San Diego, CACalifornia | — | $695.78 |
| Marin County, CACalifornia | — | $738.85 |
| San Francisco, CACalifornia | — | $734.28 |
| San Benito County, CACalifornia | — | $759.83 |
| Santa Clara County, CACalifornia | — | $741.16 |
| San Luis Obispo, CACalifornia | — | $682.60 |
| Santa Cruz, CACalifornia | — | $692.69 |
| Santa Maria, CACalifornia | — | $690.78 |
| Santa Rosa, CACalifornia | — | $698.41 |
| Stockton, CACalifornia | — | $677.98 |
| Vallejo, CACalifornia | — | $713.59 |
| Visalia, CACalifornia | — | $677.98 |
| Yuba City, CACalifornia | — | $677.98 |
| ColoradoColorado | — | $705.03 |
| ConnecticutConnecticut | — | $767.87 |
| DelawareDelaware | — | $709.34 |
| Fort Lauderdale, FLFlorida | — | $831.68 |
| Rest of FloridaFlorida | — | $784.60 |
| Atlanta, GAGeorgia | — | $751.94 |
| Rest of GeorgiaGeorgia | — | $735.96 |
| Hawaii, Guam, HIHawaii | — | $680.00 |
| IowaIowa | — | $631.69 |
| IdahoIdaho | — | $642.43 |
| East St. Louis, ILIllinois | — | $849.34 |
| Rest of IllinoisIllinois | — | $788.03 |
| Suburban Chicago, ILIllinois | — | $831.71 |
| IndianaIndiana | — | $644.93 |
| KansasKansas | — | $644.87 |
| KentuckyKentucky | — | $698.44 |
| New Orleans, LALouisiana | — | $733.71 |
| Rest of LouisianaLouisiana | — | $703.79 |
| Metropolitan Boston, MAMassachusetts | — | $747.57 |
| Rest of MassachusettsMassachusetts | — | $707.92 |
| Baltimore area, MDMaryland | — | $769.15 |
| Rest of MarylandMaryland | — | $716.87 |
| Rest of MaineMaine | — | $662.43 |
| Southern Maine, MEMaine | — | $671.28 |
| Detroit, MIMichigan | — | $810.14 |
| Rest of MichiganMichigan | — | $729.76 |
| MinnesotaMinnesota | — | $630.39 |
| Metropolitan Kansas City, MOMissouri | — | $712.14 |
| Metropolitan St. Louis, MOMissouri | — | $716.90 |
| Rest of MissouriMissouri | — | $703.46 |
| MississippiMississippi | — | $671.80 |
| MontanaMontana | — | $721.52 |
| North CarolinaNorth Carolina | — | $666.12 |
| North DakotaNorth Dakota | — | $642.04 |
| NebraskaNebraska | — | $630.00 |
| New HampshireNew Hampshire | — | $709.42 |
| Northern New JerseyNew Jersey | — | $778.37 |
| Rest of New JerseyNew Jersey | — | $763.91 |
| New MexicoNew Mexico | — | $739.86 |
| NevadaNevada | — | $699.48 |
| NYC suburbs and Long Island, NYNew York | — | $887.91 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $781.81 |
| Queens, NYNew York | — | $831.43 |
| Rest of New YorkNew York | — | $676.54 |
| OhioOhio | — | $713.51 |
| OklahomaOklahoma | — | $680.34 |
| Portland, OROregon | — | $707.04 |
| Rest of OregonOregon | — | $681.48 |
| Metropolitan Philadelphia, PAPennsylvania | — | $760.76 |
| Rest of PennsylvaniaPennsylvania | — | $705.59 |
| Rhode IslandRhode Island | — | $719.96 |
| South CarolinaSouth Carolina | — | $693.48 |
| South DakotaSouth Dakota | — | $632.64 |
| TennesseeTennessee | — | $649.84 |
| Austin, TXTexas | — | $713.68 |
| Beaumont, TXTexas | — | $702.58 |
| Brazoria, TXTexas | — | $695.13 |
| Dallas, TXTexas | — | $706.62 |
| Fort Worth, TXTexas | — | $707.29 |
| Galveston, TXTexas | — | $701.79 |
| Houston, TXTexas | — | $775.37 |
| Rest of TexasTexas | — | $703.28 |
| UtahUtah | — | $701.64 |
| VirginiaVirginia | — | $680.49 |
| Virgin Islands, VIUnited States Virgin Islands | — | $720.96 |
| VermontVermont | — | $654.39 |
| Rest of WashingtonWashington | — | $701.64 |
| King County, WAWashington | — | $745.63 |
| WisconsinWisconsin | — | $624.36 |
| West VirginiaWest Virginia | — | $765.58 |
| WyomingWyoming | — | $686.88 |
59409 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 59409 rate is calculated
Each of 59409’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 59409
RVUs × geographic indexes × conversion factor
Work14.37
14.37 RVUs× 1.000 GPCI
Practice expense3.22
3.22 RVUs× 1.000 GPCI
Malpractice4.02
4.02 RVUs× 1.000 GPCI
Adjusted RVUs
21.6100
Conversion factor
$33.4009
Medicare rate
$721.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
6,656
- Code
- 59409
- Physician work
- 14.37
- Practice expense
- 3.22
- Malpractice
- 4.02
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.37 | × 1.000 | 14.3700 |
| Practice expense | 3.22 | × 1.011 | 3.2554 |
| Malpractice | 4.02 | × 0.985 | 3.9597 |
| Total RVUs | 21.5851 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$720.96
Facility: (14.37 × 1 + 3.22 × 1.011 + 4.02 × 0.985) × $33.4009 = $720.96
Payment rules and modifiers for 59409
The CMS indicators that decide how 59409 is paid alongside other services.
CMS payment indicators · 59409
Vaginal delivery, delivery only
| Rule | CMS value | What it means |
|---|---|---|
| Global period | MMM | Maternity care: global rules don’t follow the standard pattern. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
59409 without 51 · national facility
$721.79
Vaginal delivery, delivery only
59409-51 · Second procedure: 50%
$360.90
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 59409 has changed in Puerto Rico
59409 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $720.96 | RVU26D |
| 2026-07-01 | Not available in this setting | $720.96 | RVU26C |
| 2026-04-01 | Not available in this setting | $720.96 | RVU26B |
| 2026-01-01 | Not available in this setting | $720.96 | RVU26A |
| 2025-10-01 | Not available in this setting | $775.05 | RVU25D |
| 2025-07-01 | Not available in this setting | $775.05 | RVU25C |
| 2025-04-01 | Not available in this setting | $775.05 | RVU25B |
| 2025-01-01 | Not available in this setting | $775.05 | RVU25A |
| 2024-10-01 | Not available in this setting | $798.23 | RVU24D |
| 2024-07-01 | Not available in this setting | $798.23 | RVU24C |
| 2024-04-01 | Not available in this setting | $798.23 | RVU24B |
| 2024-03-09 | Not available in this setting | $798.23 | RVU24AR |
| 2024-01-01 | Not available in this setting | $785.20 | RVU24A |
| 2023-10-01 | Not available in this setting | $811.42 | RVU23D |
| 2023-07-01 | Not available in this setting | $811.94 | RVU23C |
| 2023-04-01 | Not available in this setting | $811.94 | RVU23B |
| 2023-01-01 | Not available in this setting | $811.94 | RVU23A |
| 2022-10-01 | Not available in this setting | $820.96 | RVU22D |
| 2022-07-01 | Not available in this setting | $820.96 | RVU22C |
| 2022-04-01 | Not available in this setting | $820.96 | RVU22B |
| 2022-01-01 | Not available in this setting | $820.96 | RVU22A |
| 2021-10-01 | Not available in this setting | $824.70 | RVU21D |
| 2021-07-01 | Not available in this setting | $824.70 | RVU21C |
| 2021-04-01 | Not available in this setting | $824.70 | RVU21B |
| 2021-01-01 | Not available in this setting | $824.70 | RVU21A |
| 2020-10-01 | Not available in this setting | $849.24 | RVU20D |
| 2020-07-01 | Not available in this setting | $849.24 | RVU20C |
| 2020-04-01 | Not available in this setting | $849.24 | RVU20B |
| 2020-01-01 | Not available in this setting | $849.24 | RVU20A |
| 2019-10-01 | Not available in this setting | $842.42 | RVU19D |
| 2019-07-01 | Not available in this setting | $842.42 | RVU19C |
| 2019-04-01 | Not available in this setting | $842.42 | RVU19B |
| 2019-01-01 | Not available in this setting | $842.42 | RVU19A |
| 2018-10-01 | Not available in this setting | $844.05 | RVU18D |
| 2018-07-01 | Not available in this setting | $844.05 | RVU18C |
| 2018-04-01 | Not available in this setting | $844.05 | RVU18B |
| 2018-01-01 | Not available in this setting | $844.05 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $772.55 | RVU17D |
| 2017-07-01 | Not available in this setting | $772.55 | RVU17C |
| 2017-04-01 | Not available in this setting | $772.55 | RVU17B |
| 2017-01-01 | Not available in this setting | $772.55 | RVU17A |
| 2016-10-01 | Not available in this setting | $695.48 | RVU16D |
| 2016-07-01 | Not available in this setting | $695.48 | RVU16C |
| 2016-04-01 | Not available in this setting | $695.48 | RVU16B |
| 2016-01-01 | Not available in this setting | $695.48 | RVU16A |
| 2015-10-01 | Not available in this setting | $699.95 | RVU15D |
| 2015-07-01 | Not available in this setting | $699.95 | RVU15C |
| 2015-04-01 | Not available in this setting | $696.47 | RVU15B |
| 2015-01-01 | Not available in this setting | $696.47 | RVU15A |
| 2014-10-01 | Not available in this setting | $695.04 | RVU14D |
| 2014-07-01 | Not available in this setting | $695.04 | RVU14C |
| 2014-04-01 | Not available in this setting | $695.04 | RVU14B |
| 2014-01-01 | Not available in this setting | $695.04 | RVU14A |
| 2013-10-01 | Not available in this setting | $666.34 | RVU13D |
| 2013-07-01 | Not available in this setting | $666.34 | RVU13C |
| 2013-04-01 | Not available in this setting | $666.34 | RVU13B |
| 2013-01-01 | Not available in this setting | $666.34 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
59409 billing questions
When should 59409 be used instead of 59410?
Use 59409 for the vaginal delivery alone. 59410 covers the delivery and postpartum care.
How does 59409 differ from 59400?
59400 represents routine obstetric care that includes antepartum care, vaginal delivery, and postpartum care. Use 59409 when the reported service is the vaginal delivery only.
Are forceps or an episiotomy included?
Yes. The vaginal delivery service includes delivery with or without forceps and with or without episiotomy.
Does the usual surgical global period apply?
No. CMS identifies 59409 as a maternity code for which the usual global surgery rules do not apply.
How are other procedures performed in the same session paid?
Under CMS’s standard multiple-procedure rule, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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