CPT 59430 Postpartum Only - Telehealth


Prineville, OR
Best answers
Good morning to all you global billing masters! It's hard to believe we've come this far with telehealth and now the question arises as to whether it's appropriate or not to use telehealth POS when needing to bill with CPT 59430 postpartum care only. Have any of you had experience with this particular situation? I have a patient who delivered at the end of one calendar year, only to receive her postpartum care in the new calendar year with a totally different insurance payer. So split the global we must!

Due to COVID our large practice has decided to conduct as many telehealth appointments as possible, including but not limited to postpartum care. My original thoughts were to forgo using the telehealth POS with CPT 59430, as the guidelines reserve that guideline for E/M codes only. But now that thought process is being called into question. I'm good either way, as my physicians are doing the needed work and documenting appropriately.

I'd appreciate lots of feedback and any published documents you've found along the way regarding this very specific situation.
Per Medicare, 59430 is not on their list of 2023 telehealth approved services.
Whether or not this patient's particular payor allows it is up to the payor. I will note this - if at least some of the postpartum care was delivered in person, then I would personally feel OK using 59430. I could not find any official guidance about this.
PS - None of my business, and nothing to do with coding, but it would seem a bit risky if you are not doing any in person evaluation of all your postpartum patients.