Reviewed by certified coders + a maternal-fetal medicine physician / Updated for 2026
OB Coding Guide
OB Coding Guide
obcodingguide.com/codes/59618/
Clinical review: Sina Haeri, MD, MHSA (MFM) · Coder review pending · Drafted July 2026
59618 Delivery
CPT 59618

CPT 59618: Global OB Care, Cesarean After Attempted VBACGlobal OB Care, Cesarean After Attempted VBAC

2027 change This code is scheduled for deletion on January 1, 2027, when CPT unbundles the global maternity package. Current rules apply through 2026 dates of service. See what replaces it →
The short answer

Use 59618 to bill the full pregnancy bundle when a patient with a prior cesarean attempts a vaginal birth and the trial of labor ends in a repeat cesarean. It pays slightly more than the plain cesarean global 59510 because the practice managed a labor trial and then performed surgery. If the VBAC succeeds, the global code is 59610. If there was never a trial of labor, use 59510.

Source: CMSSource: ACOGSource: CMS MPFS 2026

When to use 59618

Report 59618 when one practice provides the complete arc of care, the patient labors toward a VBAC, and the delivery converts to a cesarean, whether for arrest of labor, non-reassuring tracing, or any other intrapartum indication. The single fact that separates this code from 59510 is the documented trial of labor after a prior cesarean, so the labor course belongs in the record in plain terms: when labor started or was augmented, how it progressed, and why the team converted. Practices that default every repeat cesarean to 59510 systematically undercode the ones that labored first.

59618 vs 59510 vs 59610
59618 · Attempt, then cesarean
  • Prior cesarean plus a documented trial of labor
  • Labor converted to a repeat cesarean
  • One practice provided the full span of care
  • Pays above 59510, reflecting labor management plus surgery
The neighboring globals
  • 59510: repeat cesarean with no trial of labor
  • 59610: the VBAC attempt succeeds vaginally
  • No prior cesarean: the 59400/59510 families
  • Split care: 59620/59622 plus antepartum codes by visit count

Documentation checklist

The premium over 59510 rides entirely on the labor trial, so the record has to show an attempt, not just an intention.

✓ Prior cesarean documented, with the diagnosis on the claim
✓ VBAC counseling and consent noted antepartum
✓ Labor course documented: onset or augmentation, progress, monitoring
✓ Indication for conversion to cesarean stated explicitly
✓ Operative note with date, indication, and technique
✓ Antepartum flow sheet with visit dates and count
✓ Postpartum visits within the payer's global window

Global package rules

59618 is the global package for this delivery outcome. Boundaries match the rest of the family: ultrasounds, non-stress tests, labs, and problem E/M visits bill separately; routine visits, the labor management, the cesarean, and postpartum care stay inside. One pregnancy still supports one global code, so a mid-course transfer breaks this package into 59620 or 59622 plus antepartum codes exactly as it would for any other route. See The Global OB Package, explained. ACOG

Reimbursement

2026 · national Medicare averages
ComponentWork RVUTotal RVU2026 rate
59618Global package41.5774.86$2,500.39

National amounts under the 2026 Medicare Physician Fee Schedule (non-facility total RVU x $33.4009 conversion factor, no locality/MAC adjustment). Commercial and Medicaid rates differ. Verify current values with your MAC before billing.

Common denials

CO-16 Labor trial not evident on the claim
Why it happens
The claim carried an attempted-VBAC code without diagnoses or records reflecting a prior cesarean and a trial of labor.
How to fix
Resubmit with the prior-cesarean diagnosis and, on review, the labor documentation showing the attempt before conversion.
Source: CMS
CO-97 Intrapartum services billed on top of the global fee
Why it happens
Labor management or routine visits inside the package were billed separately.
How to fix
The labor trial is part of 59618. Bill separately only for services outside routine care, with distinct diagnoses and the applicable modifier.
Source: NCCI
CO-236 Mixed global and component billing
Why it happens
59618 appeared with 59620, 59622, or antepartum codes for the same pregnancy.
How to fix
One structure per pregnancy. Components only when part of the care happened at another practice.
Source: NCCI
CO-50 Payer downcoded to the plain cesarean global
Why it happens
Review found no documented labor trial, so the payer repriced the claim as 59510.
How to fix
Appeal with the labor record: timed notes showing labor or augmentation and the intrapartum indication for conversion. If no trial actually occurred, accept 59510.
Source: ACOG
CO-119 Global fee already paid on the pregnancy
Why it happens
Another practice billed globally across a transfer.
How to fix
Coordinate the split: their claim corrects to antepartum-only codes, yours proceeds with the transfer date documented.
Source: CMS

FAQ

What is the CPT code description for 59618?
In plain language, 59618 covers complete routine obstetric care for a patient with a prior cesarean who attempts a vaginal birth and delivers by repeat cesarean instead: antepartum visits, the labor trial and surgery, and postpartum care as one package.
How much labor counts as a trial of labor?
There is no minute threshold in CPT. What payers look for is documented intent and activity: spontaneous or augmented labor managed with the goal of vaginal delivery, then a stated indication for conversion. A scheduled cesarean where contractions started in the waiting room does not qualify.
Why does 59618 pay more than 59510?
Because the practice did both jobs: managed a labor trial and then performed the surgery. The fee schedules price that added intrapartum work into the attempted-VBAC family.
The patient labored but never had a prior cesarean. Is that 59618?
No. The attempted-VBAC family requires the prior uterine scar. A first cesarean after labor is billed with the standard 59510 family.
What happens to the code if the patient transferred in during labor?
The global code needs the antepartum span. A practice that received the patient in labor bills the delivery component 59620, or 59622 with postpartum care, and the transferring practice bills its antepartum codes.
Which diagnosis codes support 59618?
The prior-cesarean history plus the intrapartum indication that drove the conversion, such as arrest of labor or fetal intolerance. Both belong on the claim alongside the outcome-of-delivery coding.
CPT® is a registered trademark of the American Medical Association. Educational reference only, not billing, legal, or medical advice. Maintained by Ouma Health, a maternal-fetal telemedicine practice. Printed from obcodingguide.com, content current as of July 2026.