October 16, 2025
Maternity billing can get tricky, especially when providers donβt manage the full OB package. Thatβs where CPT Code 59426 comes in.
This βmini global codeβ applies when a provider delivers seven or more antepartum visits but does not handle the actual delivery or postpartum care.
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:
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:
Document each antepartum visit clearly. Payers may deny claims if visit counts arenβt supported.
Some insurers, such as Medicaid or Care Source Ohio, require splitting claims if care spans two calendar years. Always verify payer rules.
Remember: 59426 is not part of the global OB package. It should only be used when care is unbundled.
Common denial reasons include:
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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 patientβs delivery provider before billing |
In 2025, payers continue to emphasize accurate documentation for antepartum-only codes. Correct usage ensures:
Pro Tip: Always link CPT 59426 with the correct ICD-10 pregnancy-related diagnosis code to support medical necessity.
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 youβre 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 letβs optimize your revenue cycle!
It covers seven or more antepartum visits only. It does not include delivery or postpartum care.
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 O00βO9A ICD-10 chapter. Common examples include:
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 providerβs contract status and whether delivery will be billed separately.
When I switched to Medicaid mid-pregnancy, my providerβs 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:
As someone whoβs 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 mattersβher health and her babyβs.
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