What is the duration of the postpartum (post-partum) period for billing purposes?

Postpartum Period Duration for Billing Purposes

For billing purposes, the postpartum period is traditionally defined as 6-8 weeks (42 days) after delivery, though this timeframe is increasingly recognized as inadequate for capturing the full scope of postpartum health risks and complications. 1

Traditional Billing Definition

• The standard postpartum period for billing has historically been 6-8 weeks (up to 42 days) post-delivery, reflecting the WHO's official definition and the timing of the traditional postpartum visit 1, 2
• This 6-week timeframe corresponds to when most insurance coverage for routine postpartum care typically ends 3, 4
• The postpartum visit is traditionally scheduled at 6-8 weeks after delivery and can be performed by an obstetrician, gynecologist, general practitioner, or midwife 2

Clinical Reality vs. Billing Convention

The 6-8 week billing period does not align with the actual duration of postpartum physiological changes and health risks:

• The postpartum period clinically extends to 12 weeks according to current medical definitions, with some guidelines recognizing it extends up to 12 months or longer if breastfeeding 1, 3
• Maternal mortality risk remains elevated well beyond 42 days, with 35.6% of maternal deaths occurring between 24 hours and 42 days postpartum, and mortality risk still 20% higher at 42 days to 4 months compared to baseline 1
• The heightened risks from childbirth persist up to and beyond 1 year after birth 1

Phases of Postpartum Period (Clinical Framework)

While billing typically recognizes only one period, the clinical postpartum period includes four distinct phases 1:

• Phase 1 (Acute): Up to 24 hours postpartum
• Phase 2 (Early): Day 2 to 6-8 weeks postpartum
• Phase 3 (Mid): 6-8 weeks to 6 months postpartum
• Phase 4 (Late): Up to 12 months, longer if still breastfeeding

Practical Billing Implications

For standard billing purposes, use the 6-8 week timeframe, but recognize that comprehensive postpartum care requires multiple contacts:

• Initial contact should occur within 3 weeks after delivery (in person or by phone) 3
• High-risk patients (particularly those with hypertensive disorders) require blood pressure checks within 3-10 days of delivery 5
• A comprehensive postpartum visit should occur within 12 weeks 3
• Multiple postpartum contacts may be necessary and billable to fully address patient needs 3

Special Considerations for Extended Coverage

Certain conditions warrant extended postpartum monitoring beyond the traditional 6-8 week period:

• Women with hypertensive disorders require ongoing follow-up throughout the postpartum period with transition to primary care 5
• Patients with gestational diabetes need glucose tolerance testing between 4-12 weeks postpartum 5, 3
• Women with thrombophilia or VTE risk factors may require prophylaxis continued for 6 weeks postpartum 5

Key Caveat

The arbitrary 6-8 week billing cutoff is "not fit for purpose" from a clinical standpoint 1, as many medium-term and long-term complications (depression, incontinence, sexual dysfunction) emerge months or years after childbirth when women are no longer accessing traditional postpartum care services 1. Providers should advocate for extended postpartum coverage when clinically indicated, particularly for high-risk patients.