2025 CPT code 59430

Postpartum care only (separate procedure).

Follow all relevant CPT guidelines for reporting postpartum care services. Consult the official CPT codebook for the most up-to-date guidelines.Ensure the appropriate level of service is accurately reflected in the documentation and coding.

Modifiers may be applicable depending on the specific circumstances of the service.Consult the CPT codebook and NCCI edits for appropriate modifier use.

Postpartum care is medically necessary to assess the mother's physical and mental health following delivery, address potential complications, and provide appropriate counseling and guidance on various aspects of postpartum health. Medical necessity is established through thorough documentation supporting the need for these services based on the patient's clinical condition.

The clinical responsibility involves providing comprehensive postpartum care to the mother, including physical examinations, monitoring her recovery, addressing any complications, and offering counseling on various aspects of postpartum health.This may include wound care if a Cesarean section was performed. This is generally performed by an obstetrician-gynecologist or other qualified healthcare professionals.

IMPORTANT This code is used when postpartum care is provided separately from the delivery, such as when a different provider handles the postpartum care or when the global maternity package is not billed.Other codes (e.g., global maternity packages) may be more appropriate when antepartum care, delivery, and postpartum care are all provided by the same physician.

In simple words: This code is for the doctor's visits after a mother has had a baby,separate from the actual delivery. These visits check on the mom's health, help her with breastfeeding, give advice on diet and exercise, discuss birth control,and make sure she's recovering well. The visits typically happen within six weeks after delivery.

This CPT code, 59430, encompasses the provision of postpartum care as a separate procedure, distinct from the delivery itself.It includes all office or outpatient visits following vaginal or Cesarean section delivery, focusing on the mother's physical and mental well-being, wound care (if applicable from Cesarean section), lactation counseling, nutritional guidance, exercise recommendations, birth control options review/initiation, immunization evaluations, and Pap smear collection (if indicated).The care typically spans up to six weeks post-delivery, with the initial visit potentially scheduled sooner (7-14 days post-Cesarean delivery) for wound care and then follow-up appointments as needed.This code is utilized when the provider doesn't bill for the entire global maternity package and provides only postpartum care. It includes all post-delivery E/M visits related to the pregnancy.

Example 1: A patient delivers vaginally at a hospital. She moves to a new city and seeks postpartum care from a new OB/GYN. Code 59430 is appropriate as only postpartum services are provided., A patient has a Cesarean section delivery and receives postpartum care from the same physician who performed the Cesarean section. However, the global maternity package was not billed. Only postpartum visits are billed using code 59430., A patient experiences postpartum depression and attends multiple visits for counseling and medication management. These separate visits are coded using 59430 to account for the ongoing postpartum care, distinct from the delivery itself.

Detailed medical records documenting all postpartum visits, including dates of service, physical examination findings, patient's complaints, diagnoses, treatment plans, and progress notes.Documentation should support medical necessity for each visit and the nature of the postpartum care provided.

** Code 59430 is specifically for postpartum care that is billed separately from the delivery.If the provider is billing for the global maternity package, postpartum care is included in the global code.Accurate documentation is crucial to support the medical necessity of the billed services.

  • Revenue Code: M5D (Specialist - Other)
  • RVU: Refer to the CMS Physician Fee Schedule for the most current RVU values.
  • Global Days : Not applicable; this is a separate procedure code and is not subject to global surgical package days.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Refer to historical CMS Physician Fee Schedule data for fee information.
  • Specialties:Obstetrics and Gynecology
  • Place of Service:Office, Outpatient
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