CPT 59510 cost and Medicare rate
For code 59510, cesarean delivery with care before and after delivery, Medicare's 2026 rate for the doctor's part in a hospital nationally is about $2,473. In 2024, providers nationally typically billed about $6,734. Hospitals also bill their own facility fee on top of this, and Medicare rates are a common benchmark, not what every plan pays.
What CPT 59510 is
Cesarean delivery with care before and after delivery.
Office is the rate when the service is done in a clinic, office or imaging center, and covers the whole service. Facility is the doctor's part when it is done in a hospital or surgery center, which bills its own facility fee separately. The hospital outpatient rate is Medicare's rate for that facility fee.
What Medicare pays for 59510 nationally
| Setting | Medicare 2026 | Medicare allowed 2024 | Typically billed 2024 |
|---|---|---|---|
| Hospital or surgery center (doctor's part) | $2,473.34 | $2,513.68 | $6,733.52 |
Medicare 2026 is the national fee schedule rate (conversion factor 33.4009). "Medicare allowed" and "typically billed" are averages from Medicare claims in 2024.
59510 by state
Where you were treated changes the benchmark. Medicare's 2026 rate depends on the pricing area. The table shows the rest-of-state rate and the range across each state's pricing areas; some big cities have their own, higher rate. Billed amounts are what providers typically billed in a hospital or other facility in 2024.
| State and Medicare pricing area | Doctor's part 2026 | Range in state (doctor's part) | Typically billed 2024 |
|---|---|---|---|
| California Rest of California | $2,359.30 | $2,359.30 to $2,717.95 29 pricing areas | $6,856.48 |
| New York Rest of New York | $2,310.97 | $2,310.97 to $3,059.46 5 pricing areas | $7,667.41 |
| Texas Rest of Texas | $2,397.15 | $2,382.39 to $2,642.89 8 pricing areas | $6,042.62 |
| Florida Rest of Florida | $2,662.35 | $2,662.35 to $3,164.64 3 pricing areas | $7,567.20 |
| Illinois Rest of Illinois | $2,659.68 | $2,659.68 to $3,048.58 4 pricing areas | $8,456.15 |
| Ohio Statewide | $2,418.69 | One rate statewide | $6,097.73 |
| Georgia Rest of Georgia | $2,484.56 | $2,484.56 to $2,575.41 2 pricing areas | $6,095.22 |
| Washington Rest of Washington | $2,422.79 | $2,422.79 to $2,614.07 2 pricing areas | $6,542.70 |
| Pennsylvania Rest of Pennsylvania | $2,394.68 | $2,394.68 to $2,609.21 2 pricing areas | $6,458.76 |
| Arizona Statewide | $2,390.10 | One rate statewide | $6,545.67 |
What your charge for 59510 means
Med Bill Check compares a charge with Medicare's rate and with what providers typically billed. Here is how it reads three national charges:
- Charged $2,450: Your $2,450 is close to the Medicare rate, which is a good sign. Medicare rates are a common benchmark, not what every plan pays.
- Charged $4,950: Your $4,950 is about 2 times the Medicare rate, though below what providers typically billed. If this charge is from the hospital itself, it likely includes a facility fee that this figure doesn't cover, so an itemized bill will show the split.
- Charged $9,900: Your $9,900 is about 4 times the Medicare rate and 1.5 times what providers typically billed. If this charge is from the hospital itself, it likely includes a facility fee that this figure doesn't cover, so an itemized bill will show the split.
Medicare rates are a common benchmark, not what every plan or provider charges, and never proof a bill is wrong. Enter your own charge and state on the home page for your figures.
Common billing questions for 59510
- Units: Medicare's automated limit for 59510 is 1 unit for one patient on one day (NCCI Medically Unlikely Edits). If your bill shows more, ask them to confirm the units. Medicare limits (MUE) are the most units Medicare pays automatically for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
- Duplicates and services you did not get: Look for duplicate lines, services you did not receive, and unit counts that look high.
How to question a charge for 59510
- Ask for an itemized bill with codes, units and prices. Itemized bill letter.
- Compare each line with your Explanation of Benefits if you have insurance.
- Ask the billing office to review the charge in writing, and to hold the account from collections meanwhile. Charge review letter.
- Ask for a prompt-pay or self-pay discount, or an interest-free payment plan. Discount letter.
- If it was a hospital, ask for its financial assistance policy. Financial assistance letter and which hospitals must offer it.
With your code and amount, the review letter adds the benchmark for you, for example: For reference, Medicare's 2026 fee schedule rate for code 59510 nationally is about $2,473, and Medicare's published data shows providers nationally typically billed about $6,734 in 2024.
Keep a copy of everything you send, and note the date and the name of anyone you speak to. If you have insurance, call your insurer too. They can check whether the claim was processed correctly.
Quick answers
- What is CPT 59510?
- Cesarean delivery with care before and after delivery.
- How much does Medicare pay for 59510 in 2026?
- Nationally, Medicare's 2026 rate for the doctor's part is $2,473.34.
- What do providers typically charge for 59510?
- In 2024, providers nationally typically billed $6,733.52 for 59510 in a hospital or other facility.
- Is $9,900 for 59510 too much?
- Your $9,900 is about 4 times the Medicare rate and 1.5 times what providers typically billed. If this charge is from the hospital itself, it likely includes a facility fee that this figure doesn't cover, so an itemized bill will show the split.
- How much is 59510 in Texas?
- For code 59510, cesarean delivery with care before and after delivery, Medicare's 2026 rate for the doctor's part in a hospital in Texas is about $2,397. In 2024, providers in Texas typically billed about $6,043. Hospitals also bill their own facility fee on top of this, and Medicare rates are a common benchmark, not what every plan pays.
- How many units of 59510 can be billed in one day?
- Medicare's automated limit is 1 for one patient on one day. Going over is a reason to ask, not proof of an error, since some cases are allowed with records.
Sources
- CMS Medicare Physician Fee Schedule, 2026 (pfs.data.cms.gov)
- CMS Medicare Physician and Other Practitioners by Geography and Service, 2024 data (data.cms.gov)
- CMS NCCI Medically Unlikely Edits, effective 2026-10-01
General information, not medical, legal or financial advice. Medicare rates are a common benchmark, not what every plan or provider charges. For your own bill, check with the billing office, your insurer or your doctor.
Ask Med Bill Check yourself
Enter the code or the service in plain words, your state and what you were charged, and see how it compares with Medicare's rate. Open Med Bill Check, free, no sign-up.
In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/medbillcheck/mcp and ask: “Is $4,950 for 59510 in Texas too much?”
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