Summary & Overview
CPT 59426: Antepartum Care for Seven or More Prenatal Visits
CPT code 59426 represents antepartum care for pregnant patients who receive seven or more prenatal visits, a critical component of obstetric care in the United States. This code is widely recognized by major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, making it a key billing code for OB/GYN practices nationwide. The code is used to document and bill for comprehensive prenatal care provided in a physician office setting, covering routine assessments, counseling, and monitoring throughout the pregnancy.
This publication provides an in-depth overview of CPT code 59426, including payer coverage, clinical context, and related billing considerations. Readers will gain insight into national benchmarks, policy updates, and the role of this code in the broader landscape of obstetric care. The analysis also highlights common modifiers, associated taxonomies, and relevant ICD-10 diagnoses, offering a comprehensive resource for understanding how antepartum care is coded and reimbursed. By examining payer policies and clinical guidelines, the article supports healthcare professionals and administrators in navigating the complexities of medical billing for prenatal services.
CPT Code Overview
CPT code 59426 is used to report antepartum care only for patients who receive seven or more visits during their pregnancy. This code is specific to the field of obstetrics (OB/GYN) and is typically billed when care is provided in a physician office setting (POS 11). The code encompasses routine prenatal care, including assessments, counseling, and monitoring throughout the pregnancy, but does not include delivery or postpartum care. It is designed to capture the comprehensive management of a pregnant patient over multiple visits, reflecting the standard of care for ongoing prenatal supervision.
Clinical & Coding Specifications
Clinical Context
A pregnant patient presents to a physician office for routine prenatal care. Over the course of her pregnancy, she attends seven or more antepartum visits with an obstetrics or gynecology provider. Each visit includes assessment of maternal and fetal health, monitoring for complications, and provision of education and counseling. The provider documents all visits and care delivered, but does not perform delivery or postpartum care. The service is billed using CPT code 59426 for antepartum care only, covering seven or more visits.
Coding Specifications
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Modifier
52(Reduced Services): Used when the antepartum care provided is less than the typical scope, such as fewer than seven visits or incomplete services. -
Modifier
59(Distinct Procedural Service): Used when antepartum care is provided as a distinct service from other procedures, indicating it is separate and not bundled.
| Provider Taxonomy Code | Specialty Description |
|---|---|
207V00000X |