How to Bill Antepartum Care for Multiple Providers?

When several providers in the same practice see a patient during her pregnancy, the question is whether their visits add up to one antepartum-care code (59425 or 59426) or get billed as separate E/M visits.  Knowing the rules for counting antepartum visits and the services that are covered by the routine antepartum visit can assist practices in using the right coding method for antepartum visits and prevent avoidable billing mistakes. 

Can Multiple Providers Bill for Antepartum Care? 

If multiple healthcare providers from the same OB-GYN practice saw a patient during the patient’s pregnancy, can we bill 59425 (Antepartum care only; 4–6 visits) or 59426 (7 or more visits) for the antepartum care? Or should each provider bill the individual evaluation and management (E/M) CPT® codes?

How to Report Antepartum Care for Multiple Providers

If the providers work for the same OB-GYN practice during the patient’s pregnancy, then you can total the visits to report either 59425 or 59426 for the antepartum care visits. However, if the providers saw the patient for less than four visits, then you’ll assign the appropriate E/M codes per the CPT® guidelines.

What Is Included in Antepartum Care?

According to the CPT® guidelines, antepartum care includes the following:

• Initial prenatal history and physical examination
• Subsequent prenatal history and physical examinations
• Recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation
• Biweekly visits to 36 weeks gestation
• Weekly visits until delivery
  
  What This Means for Your Practice

• Through December 31, 2026, keep totalling visits across providers in the same group: four to six is 59425, seven or more is 59426, fewer than four is an E/M per visit.
• For any patient delivering on or after January 1, 2027, find out now how each payer wants her 2026 antepartum visits billed. Sentara says 59425 or 59426; Indiana and New York Medicaid want E/M plus TH from autumn 2026. There is no single rule.
• Sort your current pregnancy list by estimated delivery date. The January and February due dates are the ones that straddle the change.
• Block 59425 and 59426 in your system for dates of service on or after January 1, 2027, so nobody bills a deleted code in week one.

Separately Reported Services

You’ll separately code any other visits or services during the antepartum time period.

Need a second set of eyes on your antepartum claims?

BillingFreedom's COBGC-certified OB/GYN coders review every maternity and gynecology claim before it goes out. Email info@billingfreedom.com, call (855) 415-3472, or request a free OB/GYN billing audit.

BillingFreedom ensures provider participation, visit counts and applicable coding rules are aligned, providing a more organized approach to antepartum billing and ensuring accurate reporting throughout the revenue cycle. 

To learn more about our outstanding medical billing services, you may not hesitate to get in touch with us through email at info@billingfreedom.com or by phone at +1 (855) 415-3472. 

Our priority is your financial peace of mind!