CPT Code for Postpartum Visit Billing with Private Insurance
The CPT code for billing a routine postpartum visit to private insurance is 59430 (postpartum care only, separate procedure).
Understanding Postpartum Visit Coding
- CPT code 59430 is specifically designated for postpartum care when provided as a separate service from delivery 1
- This code covers the routine postpartum visit typically scheduled 4-6 weeks after delivery to assess recovery and provide follow-up care 1
- Unlike other evaluation and management codes, postpartum care has its own dedicated CPT code rather than using standard office visit codes 1
Billing Considerations
- When billing private insurance for postpartum visits, no modifier is typically needed when using the dedicated postpartum code 59430 1
- If additional services beyond routine postpartum care are provided during the same visit, consider using the -25 modifier with an appropriate E/M code to indicate a separately identifiable service 1
- Documentation should include comprehensive assessment of the patient's postpartum recovery, including physical examination findings and any counseling provided 1
Common Billing Pitfalls to Avoid
- Avoid using standard office visit codes (99211-99215) for routine postpartum care as these may be rejected when the dedicated postpartum code exists 1
- Be aware that if the postpartum visit includes additional services beyond routine care (such as contraceptive management), these may require separate coding 1
- Ensure proper documentation supports the services billed, as inadequate documentation is a common reason for claim denials 1
Special Circumstances
- For telehealth postpartum visits, the same CPT code 59430 applies, but may require the addition of modifier -95 to indicate services provided via telemedicine 2
- If the postpartum visit includes additional screening services (such as postpartum depression screening or diabetes screening after gestational diabetes), these may be billed separately with appropriate CPT codes 1, 3
- For patients who had complications requiring additional visits beyond the routine postpartum check, appropriate E/M codes (99211-99215) may be used for those additional visits 1