CPT 59430
Global MMM ActiveCare after delivery
CPT 59430 Billing & Documentation Guide
CPT code 59430 (Care after delivery) is classified under Surgery (Urinary/Reproductive) with a global period indicator of MMM. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.22, a non-facility practice expense RVU of 3.68, and a malpractice RVU of 0.92, a total non-facility RVU of 7.82 and facility RVU of 4.84. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $264.33, though rates vary from $228.96 to $317.64 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59430, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 59430 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Maternity codes (separate billing rules)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 59430 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 59430
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.22 | 3.22 |
| Practice Expense RVU | 3.68 | 0.7 |
| Malpractice RVU | 0.92 | 0.92 |
| Total RVU | 7.82 | 4.84 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59430
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $273.51 | $155.74 | $260.57 - $313.1 | 29 |
| Florida | $290.69 | $190.83 | $271.24 - $313.22 | 3 |
| Georgia | $261.74 | $166.79 | $253.82 - $269.66 | 2 |
| Illinois | $285.42 | $189.24 | $267.8 - $302.36 | 4 |
| Michigan | $266.22 | $172.76 | $254.47 - $277.97 | 2 |
| North Carolina | $241.87 | $149 | $241.87 - $241.87 | 1 |
| New York | $291.55 | $180.51 | $245.92 - $317.64 | 5 |
| Ohio | $250.75 | $159.87 | $250.75 - $250.75 | 1 |
| Pennsylvania | $261.77 | $164.27 | $249.43 - $274.1 | 2 |
| Texas | $257.7 | $159.7 | $247.95 - $272.75 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 59430
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59430 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 37202 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 49010 | Column 1 (primary), can be billed with modifier | No | CPT Separate procedure definition |
Frequently Asked Questions, CPT 59430
What does CPT code 59430 mean? +
CPT code 59430 represents: Care after delivery. It's in the Surgery (Urinary/Reproductive) category with a global period of MMM.
What is the Medicare reimbursement for CPT 59430? +
The 2026 Medicare national average non-facility payment for CPT 59430 is $264.33. Rates range from $228.96 to $317.64 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59430? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 59430? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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