CPT Code 59426 Guide to Billing Antepartum Care Services

A professional give treatment about the Antepartum Care Services doctor use this code for treatement CPT Code 59426.

Maternity billing can get tricky, especially when providers don’t manage the full OB package. That’s where CPT Code 59426 comes in.

This β€œmini global code” applies when a provider delivers seven or more antepartum visits but does not handle the actual delivery or postpartum care.

What is CPT Code 59426?

According to the American Medical Association (AMA), CPT 59426 is used for antepartum care only, meaning it applies when a provider delivers seven or more prenatal visits without completing the delivery or postpartum care.

This makes it ideal for cases where:

  • A patient transfers out before delivery.
  • A pregnancy ends before delivery.
  • The provider only manages antepartum visits while another provider handles the delivery.

When to Use CPT Code 59426?

CPT 59426 should be billed when seven or more prenatal visits are documented. Anything less requires different codes:

If the provider manages the entire OB cycle (antepartum, delivery, and postpartum), use the global maternity package codes instead:

  • CPT 59400 β†’ Vaginal delivery package (antepartum + delivery + postpartum)
  • CPT 59510 / 59514 β†’ Cesarean deliveries (59510 = full package, 59514 = procedure only)

Key Considerations for Billing CPT Code 59426

  1. Accurate Visit Tracking

Document each antepartum visit clearly. Payers may deny claims if visit counts aren’t supported.

  1. Payer-Specific Guidelines

Some insurers, such as Medicaid or Care Source Ohio, require splitting claims if care spans two calendar years. Always verify payer rules.

  1. OB Global Package Exclusions

Remember: 59426 is not part of the global OB package. It should only be used when care is unbundled.

  1. Avoiding Claim Denials

Common denial reasons include:

  • Incorrect number of visits billed
  • Missing documentation
  • Overlapping with another provider’s claims
    Solution: Attach visit notes, clarify dates, and appeal with supporting records.

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Challenges & Solutions in CPT 59426 Billing

Challenge

Solution

Antepartum care across two years

Split claims per payer year

Patient transfers to another provider mid-pregnancy

Bill 59426 for completed visits; coordinate with new provider

Payer denies antepartum-only claims

Appeal with detailed encounter notes

Confusion with global codes

Confirm patient’s delivery provider before billing

Reimbursement Insights for 59426

In 2025, payers continue to emphasize accurate documentation for antepartum-only codes. Correct usage ensures:

  • Timely payments
  • Fewer denials
  • Smooth coordination between OB providers

Pro Tip: Always link CPT 59426 with the correct ICD-10 pregnancy-related diagnosis code to support medical necessity.

Final Thoughts

Understanding when and how to use CPT Code 59426 can make the difference between clean claims and costly denials. For providers who deliver antepartum care only, this code is essential to proper reimbursement.

If you’re struggling with OB billing complexities, our team at Cures Medical Billing can help. From coding accuracy to payer compliance, we ensure your maternity claims get paid faster and cleaner.

Schedule your free consultation today and let’s optimize your revenue cycle!

Frequently Asked Questions (FAQs)

It covers seven or more antepartum visits only. It does not include delivery or postpartum care.

  • 59426 = 7+ antepartum visits
  • 59425 = 4–6 antepartum visits

No. If the provider manages delivery as well, use global OB package codes instead.

The first provider bills 59426 (if 7+ visits), while the new provider bills based on care provided thereafter.

Billing 59426 requires an appropriate pregnancy-related diagnosis from the O00–O9A ICD-10 chapter. Common examples include:

  • Z34.XX – Normal pregnancy
  • O26.891 – Pregnancy-related conditions (e.g., uterine irritability)
  • O09.XX – Supervision of high-risk pregnancies

In my third trimester, I had Z34.82 (supervision of normal pregnancy, third trimester) alongside 59426. My OB documented each visit clearly, which helped ensure coverage.

Yes, 59426 is widely accepted by commercial payers and Medicaid, especially when used with correct ICD-10 coding and documentation. However, it’s crucial to confirm the provider’s contract status and whether delivery will be billed separately.

When I switched to Medicaid mid-pregnancy, my provider’s billing team helped me transition seamlessly. They explained how 59426 was billed separately from the hospital delivery charge.

Not always. Some payers require splitting claims by year or additional documentation. Always verify payer-specific rules.

Because maternity care is often spread across multiple providers, hospitals, and insurance plans, using CPT 59426 correctly:

  • Prevents billing errors or denials
  • Ensures providers are fairly compensated
  • Helps patients avoid unexpected charges
  • Keeps claims compliant with payer policy

As someone who’s been through both normal and high-risk pregnancies, I can say: clarity matters. Behind every 59426 claim is a mom-to-be trusting her team to support her. Billing accurately ensures she can focus on what really mattersβ€”her health and her baby’s.

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