CPT 59430: Outpatient Postpartum Care
Medicare pays $266 and commercial payers pay $239 on average nationally for this procedure.
CPT code 59430 describes outpatient postpartum care provided by a provider or qualified nonphysician healthcare professional for routine follow-up visits occurring up to six weeks after delivery; the service type is postpartum follow-up care and the typical site of service is the outpatient clinic or office where one or more visits address recovery and routine maternal care after childbirth.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Medicare’s mean of $265.60 sits between BUCA’s average commercial mean of $239.40 and several commercial payers with higher means, indicating Medicare reimbursement is modestly above BUCA but below carriers like Cigna and UnitedHealth Group. This positions Medicare in the mid-to-upper range of the national mix for CPT 59430 while BUCA’s mean reflects a slightly lower commercial baseline.
Dispersion (P75−P25) varies notably: Blue Cross Blue Shield shows a tight spread of $115.50 (P75 $249.90 − P25 $143.40), while Aetna’s spread is $127.80 (P75 $270.70 − P25 $142.90). The widest dispersions are Cigna at $197.90 (P75 $389.00 − P25 $196.10) and UnitedHealth Group at $214.40 (P75 $394.60 − P25 $187.20). BUCA’s interquartile spread is $122.30 (P75 $293.40 − P25 $157.10), and Medicare’s IQR is $24.00 (P75 $276 − P25 $252), reflecting much lower regional variability.