What is CPT Code 59430?
CPT Code 59430 is the?global obstetric care package?for routine maternity services, covering?antepartum care, vaginal delivery, and postpartum care?for a single pregnancy. It’s designed to simplify billing for uncomplicated pregnancies by bundling all essential services into one code.
But when should you use 59430 instead of other codes like cpt code 59425 or 59510? What does it include (and exclude)? Let’s break it down.
What’s included in CPT 59430?
The global OB package is divided into three phases:
- Antepartum Care (Prenatal Visits)Routine office visits (12-14 visits for low-risk pregnancies).Physical exams, weight checks, and blood pressure monitoring.Patient education (nutrition, labor preparation).Excludes:?Ultrasounds, lab work, or high-risk care (e.g., gestational diabetes management).
- Delivery ManagementVaginal delivery (including episiotomy or forceps, if needed).Hospital admission and labor supervision.
- Postpartum Care Follow-up visits within 6 weeks after delivery.Incision checks (if applicable).Breastfeeding support and contraception counseling.
CPT 59430 vs. Other Obstetric Codes
- 59425 (Vaginal Delivery Only):?Use 59425 if the provider didn’t manage antepartum/postpartum care.
- 59510 (Cesarean Global Package):?Applies to cesarean deliveries.
- Split Care:?If another provider handled part of the care (e.g., a midwife managed prenatal visits), bill using?59426 (antepartum only)?or?59429 (postpartum only).
Key Tip: Misusing 59430 when splitting services is a common audit trigger. Always verify who provided care during each phase.
Billing Guidelines for CPT 59430
- Reimbursement Rules Most insurers (including Medicare/Medicaid) reimburse 59430 as a?global fee?covering 90 days of care.
- Exception:?Bill separately for unrelated services (e.g., treating a UTI during pregnancy).
- Modifiers-22 (Increased Procedural Services):?For complex deliveries (e.g., severe hemorrhage).-52 (Reduced Services):?If fewer than 12 prenatal visits were provided.
- Documentation RequirementsTrack dates of all prenatal and postpartum visits.
- Note any complications requiring additional billing.
Common Pitfalls to Avoid
- Double-Billing:?Don’t charge for office visits separately if they’re included in 59430.
- Missing the Postpartum Window:?All follow-ups must occur within 42 days (6 weeks) of delivery.
- Ignoring Payer Policies:?Private insurers may have unique rules (e.g., prior authorization for global care).
Need Help Optimizing OB/GYN Billing?
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FAQs about CPT 59430
- Does 59430 cover ultrasounds or lab tests?
- No. Diagnostic tests (e.g., ultrasounds, glucose tolerance tests) are billed separately with codes like 76805 or 82947.
- Can I bill 59430 for high-risk pregnancies?
- Only if the provider managed routine care. For high-risk cases, bill additional E/M codes (e.g., 99213-99215) with modifier?-25.
- What’s the 2025 reimbursement rate for CPT 59430?
- Medicare’s national average is ~$2,100 (check your MAC’s fee schedule for updates
- Key Takeaways
- CPT 59430 streamlines billing for uncomplicated pregnancies but requires strict documentation.
- Split care scenarios demand careful code selection (e.g., 59425 vs. 59430).
- Always confirm payer-specific policies to avoid denials.
