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Billing code 59618: Attempted VBACMedicare rate & RVUs

Report 59618 when an obstetrician or qualified practitioner manages antepartum, cesarean, and postpartum care after a trial of labor following prior cesarean ends in cesarean delivery.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,500.39 for 59618 nationally in a facility.

Medicare rate · 59618

Attempted VBAC

Swap in your local Medicare rate.

Work RVUs
41.57
Total RVUs
74.86
Global days
MMM

National rate · 2026

$2,500.39

Facility setting, before claim adjustments.

See every locality for 59618 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 59618 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 59618 covers

Code 59618 represents the complete maternity-care package when a patient with a prior cesarean undertakes labor for a vaginal birth, but delivery is by cesarean. It encompasses the practitioner’s antepartum management, cesarean delivery, and postpartum care. It is generally reported by the obstetrician or group responsible for the full course of care, rather than as a delivery-only service when that practitioner provided the package.

Documentation should support the prior cesarean, attempted vaginal labor, cesarean outcome, and practitioner responsibility for antepartum and postpartum care. Choose this code instead of the complete-care code for a successful VBAC when the trial ends in cesarean; use a delivery-only or postpartum-only sibling when only that portion is furnished. CMS identifies this as a maternity code, so the usual global surgery rules do not apply. When multiple procedures are performed in the same session, CMS’s standard reduction pays the highest-valued procedure in full and other procedures at 50%.

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.

Where 59618 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

59618 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,223.51
Alaska*Unavailable$3,037.54
ArizonaUnavailable$2,415.50
ArkansasUnavailable$2,190.11
AtlantaUnavailable$2,604.90
AustinUnavailable$2,490.91
BakersfieldUnavailable$2,416.20
Baltimore/Surr. CntysUnavailable$2,676.96
BeaumontUnavailable$2,408.80
BrazoriaUnavailable$2,407.34

59618 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
59618 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 59618 rate is calculated

Each of 59618’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 · 59618

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 41.57Practice expense 19.93Malpractice 13.36

74.8600 adjusted RVUs×$33.4009 conversion factor=$2,500.39

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 59618

The CMS indicators that decide how 59618 is paid alongside other services.

CMS payment indicators · 59618

Attempted VBAC

RuleCMS valueWhat it means
Global periodMMMMaternity care: global rules don’t follow the standard pattern.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

59618 without 51 · national facility

$2,500.39

Attempted VBAC

59618-51 · Second procedure: 50%

$1,250.20

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%).

When to use modifier 51

59618 compared with similar codes

Compare codes

59618 vs 59610 vs 59620 vs 59612: national Medicare rates

Swap in your local Medicare rate.

  • 59618
    Attempted VBAC · 41.57 wRVU
    —
  • 59610
    VBAC care · 38.71 wRVU
    —
  • 59620
    VBAC delivery · 16.66 wRVU
    —
  • 59612
    VBAC delivery · 16.09 wRVU
    —

How to choose

59610VBAC care
Use 59610 for the complete maternity-care package when the attempted vaginal birth after prior cesarean succeeds; 59618 applies when delivery is by cesarean.
59620VBAC delivery
59620 covers the cesarean delivery only after an attempted VBAC. Use 59618 when the practitioner provides the complete antepartum, delivery, and postpartum package.
59612VBAC delivery
59612 is for delivery only when the patient delivers vaginally after prior cesarean. It is not the complete-care code for an attempted VBAC ending in cesarean.

Codes related to 59618

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 59618
CodeHow it relatesNational office range
Used instead
59610VBAC careComplete maternity care after prior cesarean when vaginal delivery is achieved.No office rate
59612VBAC deliveryDelivery-only service when VBAC results in vaginal delivery.No office rate
Same family
59620VBAC deliveryCesarean delivery only after an attempted VBAC, without the complete maternity-care package.No office rate
59622Postpartum carePostpartum care only following an attempted VBAC.No office rate
59614VBAC deliveryPostpartum care only following vaginal delivery after a prior cesarean.No office rate

59618 billing questions

Does 59618 include antepartum and postpartum care?

Yes. It represents the complete maternity-care package, including antepartum care, cesarean delivery after an attempted VBAC, and postpartum care.

Which code applies if the attempted VBAC succeeds?

For the complete maternity-care package when vaginal delivery follows the prior cesarean, use 59610 rather than 59618.

When should 59620 be used instead?

Use 59620 for the cesarean delivery only after an attempted VBAC when the service is limited to delivery, rather than the complete care package represented by 59618.

How does the multiple procedure reduction affect 59618?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50% under the standard reduction.

Does the usual global surgery rule apply to this maternity code?

No. CMS identifies 59618 as a maternity code, for which the usual global surgery rules do not apply.

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
RVUs for 59618PPRRVU2026_Oct_nonQPP.csv, line 6,670 (RVU26D)

Open CMS sourceHow we calculate rates

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