2026 MIPS Measure #336: Maternity Care: Postpartum Follow-up and Care Coordination

Percentage of patients, regardless of age, who gave birth during a 12-month period who were seen for postpartum care before or at 12 weeks of giving birth and received the following at a postpartum visit: breastfeeding evaluation and education, postpartum depression screening, intimate partner violence screening, postpartum glucose screening for gestational diabetes patients, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and an immunization review and update.

This measure is to be submitted a minimum of once per performance period for all patients seen for postpartum care before or at 12 weeks of giving birth during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

All patients, regardless of age, who gave birth during a 12-month period and were seen for postpartum care at a visit before or at 12 weeks of giving birth

All patients, regardless of age

AND

Patient procedure during performance period (CPT): 59400, 59410, 59430, 59510, 59515, 59610, 59614, 59618, 59622

AND

Postpartum care visit before or at 12 weeks of giving birth: M1445

Patients receiving the following at a postpartum visit:

Breastfeeding evaluation and education, including patient-reported breastfeeding
Postpartum depression screening
Intimate partner violence screening
Postpartum glucose screening for gestational diabetes patients
Family and contraceptive planning counseling
Tobacco use screening and cessation education
Healthy lifestyle behavioral advice
Immunization review and update

Breastfeeding Evaluation and Education – Patients who were evaluated for and educated about breastfeeding before or at 12 weeks postpartum.

Postpartum Depression Screening – Patients who were screened for postpartum depression before or at 12 weeks postpartum. Questions may be asked either directly by a health care provider or in the form of selfcompleted paper- or computer-administered questionnaires, and results should be documented in the medical record. Depression screening should include a self-reported validated depression screening tool (e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS)).

Intimate Partner Violence Screening – Patients who were screened for intimate partner violence before or at 12 weeks postpartum. Questions may be asked either directly by a health care provider or in the form of selfcompleted paper- or computer-administered questionnaires, and results should be documented in the medical record. Intimate partner violence screening should include a self-reported validated intimate partner violence screening tool (e.g., Abuse Assessment Screen (AAS), Extended – Hurt, Insult, Threaten, Scream (E-HITS), Humiliation, Afraid, Rape, Kick (HARK)).

Postpartum Glucose Screening for Gestational Diabetes – Patients who were diagnosed with gestational diabetes during pregnancy and were screened with a glucose screen before or at 12 weeks postpartum.

Family and Contraceptive Planning Counseling – Patients who were provided family and contraceptive planning counseling (including contraception, if necessary) before or at 12 weeks postpartum.

Tobacco Use Screening and Cessation Education – Patients who were screened for tobacco use before or at 12 weeks postpartum. Patients who used any type of tobacco who were given brief counseling (3 minutes or less) and/or pharmacotherapy.

Healthy Lifestyle Behavioral Advice – Clinicians should use discretion to determine which patients they deem appropriate for healthy lifestyle counseling. Clinicians may take into account the number of weeks that have passed since childbirth, whether the mother is breastfeeding, the degree to which the mother’s body mass index (BMI) exceeds the normal range, whether postpartum depression is present, and the mother’s own feelings and perceptions of her body weight. Counseling should include suggestions around healthy eating and staying active. If deemed necessary by the clinician, the conversation about healthy lifestyle choices could include a follow-up plan, including a referral to a specialist such as a registered dietitian nutritionist, primary care provider, or mental health professional for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling.

Immunization Review and Update – Patients whose immunization records were reviewed and who were provided with indicated immunizations, including completing series initiated antepartum or postpartum, at or before 12 weeks postpartum.

To satisfactorily meet the numerator ALL components (breastfeeding evaluation and education, postpartum depression screening, intimate partner violence screening, postpartum glucose screening for patients with gestational diabetes, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and immunization review and update) must be performed according to the definitions provided above.

NUMERATOR OPTIONS:

Performance Met: Postpartum screenings, evaluations, and education performed (G9357)

OR

Performance Not Met: Postpartum screenings, evaluations and education not performed (G9358)

Managing and ensuring concrete postpartum follow-up after delivery is a critical challenge to the health care system impacting the quality of care mothers receive. The American College of Obstetricians and Gynecologists (ACOG) sees the weeks following birth as a critical period for a woman and her child that sets the stage for long-term health and well-being. As such, this “fourth trimester” should include a comprehensive postpartum visit with a full assessment of physical, social, and psychological well-being.

Postpartum follow-up for depression screening, breastfeeding evaluation and education, family and contraceptive planning counseling, glucose screening for gestational diabetes, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and immunization review and update are important risk factors to evaluate after childbirth. Maternal depression is one of the most common perinatal complications; however, the disorder remains under recognized, underdiagnosed, and undertreated. The various maternal depression disorders are defined by the severity of the depression and the timing and length of the episode. Studies report that 3 to 25 percent of women experience major depression during the year following childbirth.

Approximately forty-one percent of women experience intimate partner violence in their lifetimes, and sexual and gender minorities are at greater risk of experiencing intimate partner violence [1]. Intimate partner violence significantly affects physical and mental health [2]. In a systematic review of high-income country data, intimate partner violence tripled the odds of postpartum depression [3].

Establishing the diagnosis of gestational diabetes mellitus offers an opportunity not only to improve pregnancy outcomes, but also to decrease risk factors associated with the subsequent development of type 2 diabetes. The ACOG Committee on Obstetric Practice recommends that all women with gestational diabetes mellitus be screened at 6–12 weeks postpartum and managed appropriately.

Tobacco and nicotine use is still a major contributor to morbidity and mortality in women and men. Women who stop using tobacco and nicotine receive an immediate health and financial benefit.

ACOG acknowledges that unintended pregnancies are common and that pregnancy spacing is important for healthy families. In addition, the greatest risk of low birth weight and preterm birth occurs when the interconception interval is less than 6 months. The ACOG sees the weeks following birth as a critical period for a woman and her child that set the stage for long-term health and well-being.

The ACOG 2018 Postpartum Toolkit states that immunization in the postpartum period is a simple and effective way to protect the woman and her child from certain infections, particularly when the woman was not immunized during pregnancy. Although obstetrician–gynecologists encourage women of childbearing age to be current with their immunizations before the peripartum period, postpartum maternal immunization can prevent acute maternal infection and potential spread of illness from the woman to her newborn. Infants of breastfeeding women acquire maternal antibodies through breast milk.

This measure is a measure of the adequacy of the care provided for those that come for postpartum care, as patients who do not have postpartum visits are excluded from this measure.

Although certain postpartum conditions, such as depression, remain an underrecognized and undertreated condition for all low-income women, this is especially the case for those from racial and ethnic minority groups. A retrospective study of New Jersey’s Medicaid program found that Black and Latina women had particularly low treatment initiation rates for postpartum depression [4]. Postpartum care disparities similarly existed for general postpartum care, postpartum glucose screening, and family and contraceptive planning counseling among racial and ethnic minority groups [5,6]. Access to care barriers, health literacy variations, and care coordination challenges may also play a role in postpartum care disparities [7]. Potential solutions to improve postpartum testing rates included proactively contacting patients, establishing educational programs, and distributing mailings [8]. These studies suggest that successful implementation of this measure’s intent may have positive downstream impacts on disparities in postpartum care and maternal and children’s outcomes overall.

References

Centers for Disease Control and Prevention. “Fast Facts: Preventing Intimate Partner Violence.” October 11, 2022. Fast Facts: Preventing Intimate Partner Violence |Violence Prevention|Injury Center|CDC.
Chisholm, C., Bullock, L., and Ferguson 2nd, J. “Intimate Partner Violence and Pregnancy: Epidemiology and Impact.” American Journal of Obstetrics & Gynecology, vol. 217, no. 2., 2017, pp. 141-144. Intimate partner violence and pregnancy: epidemiology and impact - PubMed (nih.gov).
Tran, T., Murray, L., and Vo, T. “Intimate Partner Violence During Pregnancy and Maternal and Child Health Outcomes: A Scoping Review of the Literature from Low-and-Middle Income Countries from 2016-2021.” BMC Pregnancy and Childbirth, vol. 2, 2022. Intimate partner violence during pregnancy and maternal and child health outcomes: a scoping review of the literature from low-and-middle income countries from 2016 - 2021 - PMC (nih.gov).
Kozhimannil, K.B., Trinacty, C.M., Busch, A.B., Huskamp, H.A., Adams, A.S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619-625. https://doi.org/10.1176/ps.62.6.pss6206_0619.
Howell, E.A., Padrón, N.A., Beane, S.J. et al. (2017). Delivery and payment redesign to reduce disparities in high risk postpartum care. Maternal Child Health J, 21(3), 432–438. https://doi.org/10.1007/s10995-016-2221-8.
Mathieu, I.P., Song, Y., Jagasia, S.M. (2014). Disparities in postpartum follow-up in women with gestational diabetes mellitus, Clinical Diabetes, 32(4), 178-182. https://doi.org/10.2337/diaclin.32.4.178.
Parekh, N., Jarlenski, M., Kelley, D. (2018). Prenatal and postpartum care disparities in a large Medicaid program. Matern Child Health J, 22, 429–437. https://doi.org/10.1007/s10995-017-2410-0.
Carson, M.P., Frank, M.I., Keely, E. (2013). Original research: Postpartum testing rates among women with a history of gestational diabetes—Systematic review, Primary Care Diabetes, 7(3), 177-186. https://doi.org/10.1016/j.pcd.2013.04.007.