CPT Code 59426 Guide to Billing Antepartum Care Services

CPT 59426 refers to “Antepartum care only; 7 or more visits” provided during a pregnancy. This code is used when a healthcare provider delivers prenatal care but does not perform the delivery or postpartum care.

When I transferred providers mid-pregnancy due to insurance changes, my new OB used this code to bill for the care she provided from week 24 until delivery. It helped everyone keep things clear and organized, especially for billing.

This code includes:

• Routine prenatal visits (usually monthly, then more frequently later)
• Monitoring of vitals and fetal growth
• Lab test coordination and patient education
• Nutritional and birth planning discussions

Think of it as the complete prenatal journey, without the delivery part. Every time my provider checked my baby’s heartbeat or talked through my birth worries, it was part of this code.

No. CPT 59426 requires at least 7 documented visits. If fewer visits are provided—due to a late transfer of care, miscarriage, or other reasons—your provider should instead bill individual E/M visits (like 99213 or 99214) or use codes 59425 (4-6 visits) or 59400 (global OB package, if applicable).

I once had a friend who transferred in at 32 weeks and had only 5 visits before delivery. Her OB billed 59425 instead of 59426 to reflect that accurately.

No. This code only covers prenatal care, not labor, delivery, or the postpartum checkup. If a provider performs the delivery and postpartum care, those services are billed separately using:

• 59409 – Vaginal delivery only
• 59430 – Postpartum care only

I had a high-risk pregnancy and needed to change OBs twice. Each provider billed only for the parts of care they handled. It was reassuring to know billing codes could adapt to real-life situations.

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.

In group practices, if multiple providers collectively provide 7+ prenatal visits, the group can bill 59426 as a shared code. Accurate visit logs and chart documentation are essential.

During my prenatal care, I saw three different OBs due to rotating schedules. Since they were all in the same group, their visits added up under one 59426 charge.

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 matters—her health and her baby’s.