CPT 59426: Mini-Global Antepartum Care, Seven or More Visits
Medicare pays $1070 and commercial payers pay $1118 on average nationally for this procedure.
CPT code 59426 is a mini-global obstetric service describing antepartum care when the provider delivers seven or more prenatal visits but does not complete the entire global maternity package; it applies when a patient transfers out before delivery or the pregnancy terminates prior to delivery, and when a provider who transfers in performs the delivery without reporting a global delivery code. The service type is obstetric antepartum care (mini-global), and the typical site of service is outpatient obstetrics clinic or physician office (antepartum visits) with potential delivery site in a hospital if delivery occurs under the provider's care.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Nationwide, Medicare’s mean rate of $1,070.10 sits very close to BUCA’s average commercial mean of $1,118.40, with BUCA about $48.30 higher — a narrow gap that positions Medicare near the middle of the national commercial range for CPT 59426. That proximity suggests commercial plans on average reimburse only modestly above Medicare for this service, while some commercial payers extend substantially higher means (e.g., Cigna and UnitedHealth Group).
Dispersion across payers varies: compute P75−P25 ranges to compare variability. Blue Cross Blue Shield shows a range of $480.50, Aetna $605.10, Cigna $876.70, UnitedHealth Group $825.10, and BUCA $578.00; Medicare’s interquartile spread is $92.00. Medicare is the tightest by far, while Cigna is the widest, with UnitedHealth Group also showing substantial dispersion. These differences highlight where commercial reimbursements are most variable versus Medicare’s consistency.