2025 CPT code 59426

Antepartum care only; 7 or more visits.

Follow all guidelines from the AMA CPT manual and relevant payer guidelines for billing antepartum care.Code 59426 should not be bundled with codes for delivery and postpartum care, unless the global package applies.Modifiers may be necessary based on individual circumstances.

Medical necessity for 59426 is established by the need for regular antepartum care during a pregnancy, ensuring the health and well-being of both mother and fetus.Frequency of visits may vary based on risk factors and clinical judgment but should be documented with justification.

The clinical responsibility for code 59426 includes providing comprehensive antepartum care, which involves a thorough initial history and physical examination, subsequent examinations, monitoring maternal and fetal well-being, recording vital signs, conducting routine tests (e.g., urinalysis), and providing education and counseling to the mother.

IMPORTANT For 1-3 antepartum visits, use E/M codes. For 4-6 visits, use CPT code 59425.If the provider also performs the delivery, or provides postpartum care, appropriate global codes (e.g., 59400, 59410) may apply.

In simple words: This code is for doctors who see a pregnant woman for checkups seven or more times during her pregnancy but don't deliver the baby or provide care afterward. This may happen if the woman switches doctors, the pregnancy ends early, or she goes to a different doctor for delivery.

CPT code 59426 reports antepartum care only, encompassing seven or more visits during a pregnancy.This code is utilized when the provider furnishes a significant portion of the antepartum care but does not perform the delivery or provide postpartum services due to various circumstances such as patient transfer, pregnancy termination, or referral to another provider for delivery.The code includes the initial and subsequent prenatal examinations, recording of vital signs, fetal heart tones, urinalysis, and routine monitoring.It excludes delivery and postpartum care, which are reported separately using relevant codes.This code is a "mini-global" covering antepartum visits.

Example 1: A patient transfers to a new practice after six prenatal visits. The new provider continues antepartum care until delivery but does not handle the delivery. They bill 59426 for the seven or more visits they performed., A pregnancy terminates prematurely, and the provider has seen the patient for eight prenatal visits.The provider submits 59426 for the antepartum care only since no delivery or postpartum care was provided., A patient is referred to a high-risk OB specialist for specialized management. The primary care provider used code 59426 to bill for 10 antepartum visits provided before the referral.

Detailed medical records are necessary for each antepartum visit including: patient demographics, date of service, chief complaint, relevant past medical history, physical examination findings (e.g., vital signs, weight, fetal heart tones, fundal height), results of any tests performed (e.g., urinalysis),clinical decision making, and plan of care.Documentation should justify medical necessity for each visit.

** This code is specifically designed for situations where complete global obstetric care is not provided by the same provider group.Payers may have specific guidelines regarding the use of this code, so it is crucial to consult individual payer policies before billing.

  • Revenue Code: M5D (Specialist - Other)
  • RVU: This information is not available in the provided sources.Consult the AMA CPT codebook or a relevant payer's fee schedule for RVU values.
  • Global Days : This code does not have a global surgical period because it only covers antepartum care.
  • Payment Status: Active
  • Modifier TC rule: No TC modifier is applicable to this code.
  • Fee Schedule : The provided sources do not contain information on historical fee schedules. This information is payer specific and can vary greatly. Consult fee schedules for relevant payers for historical data.
  • Specialties:Obstetrics and Gynecology
  • Place of Service:Office, Outpatient
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