FAQs: CPT® 2027 coding for delivery care

How is vaginal delivery reported in 2027?

Two new codes: 

59431 – Vaginal delivery, with or without episiotomy

59432 – Vaginal delivery, with or without episiotomy; after previous cesarean delivery

These include delivery of the placenta and repair of first- or second-degree lacerations done by the delivering physician or other QHP or their group, plus routine same-day postpartum care.

How is cesarean delivery reported in 2027?

Two new codes: 

59502 – Cesarean delivery; primary

59503 – Cesarean delivery; repeat

Each includes incision, delivery, placenta and closure. Typically reported once per delivery event regardless of number of fetuses. Labor management may be separately reported when applicable (e.g., failed labor before primary cesarean, TOLAC before repeat cesarean).

How would VBACs (59610–59614) and cesarean deliveries following VBACs (59618–59622) be coded in 2027? 

For 2027, vaginal birth after cesarean (VBAC) delivery is coded with 59432, Vaginal delivery, with or without episiotomy; after previous cesarean delivery. A patient who has a cesarean following a VBAC would be coded with 59503, Cesarean delivery; repeat, regardless of whether or not they attempted a vaginal delivery, as they had previously delivered via cesarian. If a patient has only had previous vaginal delivery(ies) and now has a cesarean, code 59502, Cesarean delivery; primary would be reported.    

Keep in mind that for any delivery, if labor management is performed, it will be reported in addition to any delivery service provided. For patients who have had a previous cesarean and want to have a VBAC, that patient would qualify for complex labor management.  

If one of our doctors is the primary surgeon for cesarean and one of our doctors is the assistant, do we still use the cesarean delivery CPT code with modifier 80?  

This is correct; the basic assistant surgeon principle still applies in 2027. However, beginning Jan. 1, 2027, the old cesarean codes 59510, 59514 and 59515 are deleted. Cesarean delivery is reported with: 

59502 – primary cesarean delivery 

59503 – repeat cesarean delivery 

For the physician who actually serves as the assistant surgeon, modifier 80 remains the CPT modifier for an assistant surgeon.  

The major difference from the 2026 maternity structure is that you would no longer have the issue of the primary physician reporting a global cesarean code while the assistant reports the "delivery-only” code.  

For a multiple gestation delivery, is a modifier required for a vaginal delivery and cesarean delivery when the procedures are performed in the same session? 

When both a vaginal and cesarean deliveries are performed at the same session by the same delivering physician for multiple fetuses, the primary procedure would be reported as listed and the secondary procedure would be reported with modifier 51 appended to indicate multiple procedures.  

Do codes 59431 and 59432 include vacuum-assisted delivery? 

The vaginal delivery codes are used for vacuum-assisted deliveries and other operational deliveries; when appropriate, the vaginal delivery code may be appended with modifier 22 (increased procedural services) to indicate that the work required to perform the delivery was substantially greater than typically required. Documentation must support that the delivery required additional physician or QHP effort, time, technical difficulty, or severity of the patient's condition significantly exceeded the norm. 

How are perineal laceration or episiotomy repairs handled?

First-or second-degree lacerations or episiotomy repairs are not separately reported by the delivery physician or other QHP as that work is included in the vaginal delivery code being reported.

If performed by an unrelated clinician, code 59300 may be reported for first-or second-degree repair.

59300 – Repair of first or second-degree episiotomy or laceration, by other than attending physician or other qualified health care professional performing vaginal delivery care (separate procedure)

Third-and fourth-degree lacerations or episiotomy repairs are separately reportable procedure codes regardless of who is reporting the delivery.

59433 – Repair of episiotomy or laceration; third-degree laceration

59434 – Repair of episiotomy or laceration; fourth-degree laceration

How are multiple gestations coded?

Labor management: report one complex labor management code per calendar date regardless of number of fetuses. Labor is complex by default for multiples.

Delivery: Report one cesarean code regardless of number of fetuses delivered by cesarean; report one vaginal delivery code per fetus delivered vaginally. For mixed-mode deliveries (e.g., one vaginal, two cesarean), report one vaginal delivery code and one cesarean code.

How are cesarean hysterectomies reported?

Subtotal or total hysterectomy performed at the same encounter as a cesarean is separately reportable with a new code, 59504, and may be billed by the same or a different physician than the one reporting the cesarean.

How do we report 59504 if two different physicians did the surgery? For example, one provider did the cesarean delivery and a Gynecologic Oncology physician did the hysterectomy.

The new code 59504 for hysterectomy performed at the same encounter as a cesarean was created specifically for when a separate physician is performing the hysterectomy from the physician performing and reporting the cesarean. Code 59504 may also be reported by the same physician reporting the cesarean. When the same physician performs both the cesarean delivery and hysterectomy, 59504 should be reported with modifier 51.  

Additional resources

• Overview: CPT® 2027 Maternity Care Services code changes
• FAQs: Preparing for the CPT® 2027 Maternity Care Services code changes
• FAQs: CPT® 2027 coding for maternity care spanning transition date 
• FAQs: CPT® 2027 coding for antepartum care (prenatal)
• FAQs: CPT® 2027 coding for labor management
• FAQs: CPT® 2027 coding for postpartum care