CPT Code 59430: Postpartum Care Only

What is CPT code 59430?

CPT code 59430 refers to postpartum care provided separately from the global maternity package. It covers routine postpartum visits (usually 1–2 visits, typically around 6 weeks after vaginal delivery) and includes:

• Evaluation of the patient’s physical and emotional recovery
• Breastfeeding and infant care counseling
• Contraceptive planning, pelvic exam, and postpartum depression screening
• Follow-up for any complications related to the delivery

This code applies to an established patient when different providers handled antepartum care and delivery, or when global billing is not appropriate (e.g., out-of-network or transferred care cases).

Documentation requirements

To support the use of CPT code 59430, providers must include:

• Date of delivery and rationale for separate procedure billing
• Assessment of healing and emotional status
• Details on contraceptive counseling, breastfeeding support, and postpartum care procedures
• Results of physical exam, including any postpartum complications

Billing guidelines

CPT code 59430 is billed for postpartum care services when they are not included in the global maternity package (such as CPT codes 59400, 59510, 59610, or 59618). This code applies specifically when postpartum visits are rendered as a separate procedure, rather than part of the standard antepartum, delivery, and postpartum care bundle.

This may occur in the following situations:

• Different providers performed the delivery, antepartum, and postpartum care
• The patient changed providers or insurance coverage during the maternity period
• The provider offering postpartum care did not perform the vaginal delivery
• The provider is out-of-network, and global billing is not applicable
• The provider only completed postpartum visits and not other components of maternity care

To ensure accurate billing for CPT 59430:

• Bill 59430 only after the postpartum service has been fully completed, typically 1–2 visits within 1–12 weeks after delivery
• Include the date of delivery and clearly state the reason for separate billing, such as unbundled services or care provided by a different physician
• Ensure proper documentation supports that only postpartum care procedures were performed, and that antepartum care or the vaginal delivery was not part of the service
• Submit relevant modifier codes (e.g., modifier -55 if applicable for postpartum only care) if required by the payer
• Use corresponding ICD-10 diagnosis codes that indicate a postpartum visit, such as Z39.2 (Routine postpartum follow-up)

Claims should be submitted only when the established patient received standalone postpartum care, and the services are not duplicative of those previously billed as part of a global delivery package. If members were seen in the office setting, document all postpartum care procedures, including depression screening, breastfeeding support, and contraceptive planning.

When billing 59430, be prepared for audits and verify that your documentation aligns with payer policy. This includes reporting structured care like vaginal delivery antepartum and postpartum visits when performed independently.