CPT Code 59426 Antepartum Care Only (7 + Visits) Mini-Global Billing Guide

Code Description

CPT Code 59426 is a mini-global maternity code for providers who deliver seven or more antepartum visits without rendering the complete global package of prenatal, delivery, and postpartum services.

This situation commonly occurs when a patient transfers out of the practice before delivery or if the pregnancy terminates before delivery. It is also used when a provider delivers part of the antepartum care but performs the delivery without completing all prenatal visits, as the patient transfers in from another provider, and payer policy prohibits billing the full global maternity code (e.g., 59400). This code ensures proper reimbursement for substantial prenatal involvement without overbilling for unrendered services.

Purpose

This code captures significant antepartum care when global maternity billing is not appropriate, protecting providers from revenue loss in transfer or partial-care cases.

Clinical Scenarios Where 59426 Is Applicable

• Patient receives ≥7 prenatal visits, then changes providers before delivery.
• Pregnancy ends before delivery after seven or more prenatal visits.
• Patient transfers in from another provider mid-pregnancy, and the payer prohibits the use of the full global maternity code.
• Split-care agreements where another provider or practice performs delivery.

Procedure Overview for 59426

Overview:

This code applies when a provider delivers a substantial portion of prenatal care, specifically, seven or more documented visits, but not the entire maternity package.

1. Track and document each prenatal visit with detailed notes to ensure accurate record-keeping.
2. Verify total visits meet or exceed seven.
3. Report 59426 with the correct date range for those visits.
4. Coordinate with other providers to avoid overlapping claims for the same maternity period.

Setting

Typically billed in OB/GYN offices, clinics, or hospital-based practices where care is transferred mid-pregnancy or pregnancy is not carried to delivery.

Documentation Requirements for 59426

• Exact number of prenatal visits with corresponding dates.
• Clinical details from each visit (assessment, vitals, labs, ultrasound findings, patient education).
• Date range for antepartum care period.
• Evidence that delivery and/or postpartum care was handled separately.

Billing and Reimbursement Tips for 59426

• Bill once per pregnancy, not per visit.
• Ensure visit count and date range are accurate.
• Avoid double-billing with other maternity codes by confirming provider responsibilities.
• For partial care with delivery, use the appropriate delivery codes in conjunction with 59426, if permitted by the payer.

Maximizing Revenue for Antepartum-Only Care With BillingFreedom

With BillingFreedom’s OBGYN medical billing services, your substantial prenatal work is never undervalued, even when delivery happens elsewhere. We specialize in navigating mini-global codes, such as 59426, ensuring you receive payment for the care you provide without delays or denials.

We help you:

• Capture every dollar for 7+ prenatal visits when complete global billing isn’t allowed.
• Avoid reimbursement gaps through precise, payer-compliant coding.
• Accelerate cash flow with clean, fast claim submissions.
• Handle complex split-care scenarios seamlessly.
• Reduce administrative burden so your team can focus on patient care.

Every prenatal visit counts, and we make sure every one of them is billed correctly.

BillingFreedom, where your maternity care expertise meets maximum financial return.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!