Delivery and postpartum care

Applies to members of:

All plans, except self-funded plans with a Maternity exclusion for dependents

Routine maternity services coverage

Routine maternity services are not synonymous with preventive benefit with no cost share. Consult plan documents for specific routine maternity benefits. 

Self-funded plans with a Maternity exclusion for dependents will deny all services except routine lab work.

Clinical edit: Obstetric Services, Global Care

Claims will deny Evaluation and Management services (99202-99215) when billed with a diagnosis of post-partum care uncomplicated postpartum care (ICD-10 codes Z39-Z39.2), contraceptive management (ICD-10 codes Z30.011, Z30.013-Z30.09), or family planning advice when a delivery care only service (59409, 59514, 59612, 59620) has been billed in the past 42 days (6 weeks) by any provider.

AMA CPT manual instructs postpartum care cannot be reported as a separate E/M service during the postpartum period, whether performed by the same provider who performed the delivery or by a different provider. Postpartum care is correctly reported.

For both professional and facility claims, claims will be denied when a delivery procedure code is billed and an outcome of delivery diagnosis isn't also reported on the claim. This is in accordance with Chapter 15 of the ICD-10 official coding and reporting guidelines.

Delivery and postpartum care billing

Prenatal package with delivery and postpartum care (7 or more prenatal visits)

Bill global package following delivery, entering the delivery date for the date the service was provided. Note: The post-partum visit is inclusive to this and not separately payable within a 42-day period for normal delivery.

  • Codes: Use 59400, 59510, 59610, and 59618
  • From/To dates (Box 24A CMS-1500): Indicate delivery date
  • Quantity (Box 24G CMS-1500): One
  • Place of service: Inpatient
  • Notes section: List prenatal visit dates or claim will deny.
  • Fill in the EXACT LMP date in box 14 of the CMS-1500.
  • Other considerations apply when a patient is treated for an illness.

Delivery only (no prenatal or postpartum care)

Bill newborn facility charges on a separate claim from the mother's charges. Do not combine the newborn and mother's charges in one claim.

Bill delivery immediately after service is rendered.

  • Codes: Use 59409, 59514, 59612, and 59620
  • From/To dates (Box 24A CMS-1500): List exact delivery date
  • Quantity (Box 24A CMS-1500): One
  • Fill in the EXACT LMP date in box 14 of the CMS-1500.

Delivery & postpartum care (no prenatal)

Bill newborn facility charges on a separate claim from the mother's charges. Do not combine the newborn and mother's charges in one claim.

Delivery may be billed following delivery,  entering the delivery date for the date the service was provided. Note: The post-partum visit is inclusive to this and not separately payable within a 42-day period for normal delivery.

  • Codes: Use 59410, 59515, 59614, and 59622
  • From/To dates (Box 24A CMS-1500): List exact delivery date
  • Quantity (Box 24A CMS-1500): One
  • Fill in the EXACT LMP date in box 14 of the CMS-1500.

Newborn billing, Medicaid patients

Newborn services must be submitted separately from the mother, using the newborn's Medicaid ID number.

  • The Medicaid ID number is issued by the State of Michigan, not Priority Health. It may take 30-60 days to be processed. 
  • The newborn will appear in CHAMPS or MI Health.
  • Until Priority Health receives the enrollment file from the State and enrolls the newborn as a member, claims for the newborn will deny.
  • Check the newborn's enrollment status in Member Inquiry before billing or, after a denial, wait a minimum of 30 days to resubmit.

Postpartum care only (no prenatal, no delivery)

Postpartum care can be billed as a separate service only when provided by a physician or group practice that did not perform the delivery services.

  • Codes: Use 59430 (use when this service has not been provided as part of the global or delivery package)
  • From/To dates (Box 24A CMS-1500): Exact postpartum service date
  • Quantity (Box 24A CMS-1500): One
  • List postpartum date in box 19 HCFA 1500 for paper claim or EDI - EDI-X-12 format list postpartum date in NTE segment
  • Fill in the EXACT LMP date in box 14 of the CMS-1500.

Multiple births

To report multiple birth deliveries:

  • "Baby A" is billed with a global code for vaginal delivery on first claim line and only the vaginal delivery code is billed for "Baby B" on a second claim line.
  • When twins are delivered by vaginal method, bill the code with the highest RVU as the global procedure and the second delivery with the principle procedure modifier.
  • If more than a twin delivery occurs, such as triplets or quadruplets, report the total number of fetuses delivered after the first fetus in the "Units" box.

Multiple births by cesarean section

  • When twins are delivered by cesarean section, only one code should be billed.