Updates and reminders
Published November 4, 2021
Per the existing payment
policy on maternity services, the delivery including postpartum care codes include both inpatient and outpatient postpartum services. If a single provider or multiple providers within the same group practice only provide the delivery and after delivery inpatient visit and not all the subsequent outpatient postpartum care 6-8 weeks after delivery, the “delivery only” codes should be billed as follows:
- 59409 – Vaginal delivery only (with/without episiotomy and/or forceps)
- 59514 – Cesarean delivery only
- 59612 – Vaginal delivery only, after previous cesarean delivery (with/without episiotomy and/or forceps)
- 59620 – Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
If a single provider or multiple providers within the same group practice provide the delivery and the inpatient and outpatient postpartum services 6-8 weeks after the delivery, the “delivery including postpartum” codes should be billed as
follows:
- 59410 – Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care
- 59515 – Cesarean delivery only; including postpartum care
- 59614 – Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care
- 59622 – Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care
Per the maternity services payment policy, only one submission of postpartum care will be allowed per pregnancy. If a provider bills 59430-postpartum care only (separate procedure) and the medical records support the rendering of the postpartum
care 6-8 weeks after the delivery and there is a prior submission from a provider for the delivery including postpartum, that delivery reimbursement will be overturned and recovered. The provider billing the delivery including postpartum code will
then need to supply medical records supporting that they provided the outpatient postpartum care to be reimbursed.
Sign in to your OneHealthPort account to review the billing criteria in the “Maternity Services” payment policy.