Reviewed by certified coders + a maternal-fetal medicine physician / Updated for 2026
OB Coding Guide
OB Coding Guide
obcodingguide.com/codes/59426/
Clinical review: Sina Haeri, MD, MHSA (MFM) · Coder review pending · Drafted July 2026
59426 Delivery
CPT 59426

CPT 59426: Antepartum Care Only, 7 or More VisitsAntepartum Care Only, 7 or More Visits

2027 change This code is scheduled for deletion on January 1, 2027, when CPT unbundles the global maternity package. Current rules apply through 2026 dates of service. See what replaces it →
The short answer

Use 59426 when your practice provided 7 or more routine antepartum visits but another practice performed the delivery. It is one flat bundle billed once after your care ends: 7 visits and 13 visits pay the same. With 4 to 6 visits the code is 59425, and with 1 to 3 visits you bill each as an E/M service. Never bill it alongside a global code for the same pregnancy.

Source: CMSSource: ACOGSource: CMS MPFS 2026

When to use 59426

59426 is the code for the practice that carried most of a pregnancy and then lost the delivery: the patient moved at 36 weeks, risk escalated and she was referred to a tertiary center, or she switched practices late. Count the routine antepartum visits, and at 7 or more this is your code, billed once with a quantity of one. The count caps nothing clinically, but it caps payment: there is no incremental fee past the seventh visit, which is the economic argument for keeping deliverable patients rather than referring them out. When the pregnancy ends before delivery, for example a loss managed with 59812, the antepartum codes still apply to the visits you provided.

59426 vs 59425
59426 · 7+ visits
  • 7 or more routine antepartum visits documented
  • Another practice performs the delivery
  • One unit covers the entire span, even 13 visits
  • Billed once, after your care ends
59425 · 4–6 visits
  • Routine visit count landed at 4, 5, or 6
  • Same split-care logic, smaller bundle
  • 1–3 visits: bill per-visit E/M instead
  • Delivered it yourself? The global code absorbs these visits

Documentation checklist

Payers approve this code on the strength of the visit log and the clean handoff, so document both like the claim depends on it.

✓ Antepartum flow sheet with every routine visit dated, showing 7 or more
✓ Date care ended and the reason: transfer, referral, or relocation
✓ Receiving practice identified where known, so global claims reconcile
✓ Problem visits billed separately as E/M with distinct diagnoses, not mixed into the count
✓ Quantity of one on the claim line
✓ Last visit date as the date of service unless the payer specifies otherwise

Global package rules

59426 is the largest fragment of a broken global package, and it still pays a fraction of one. The visits themselves are the same visits 59400 would have covered; what changed is who delivers. Services outside routine antepartum care, ultrasounds like 76805, non-stress tests, labs, and problem E/M visits, bill separately exactly as they would inside a global pregnancy. See The Global OB Package, explained. ACOG

Reimbursement

2026 · national Medicare averages
ComponentWork RVUTotal RVU2026 rate
59426Antepartum care14.3031.60$1,055.47

National amounts under the 2026 Medicare Physician Fee Schedule (non-facility total RVU x $33.4009 conversion factor, no locality/MAC adjustment). Commercial and Medicaid rates differ. Verify current values with your MAC before billing.

Common denials

CO-236 Antepartum code billed with a global code
Why it happens
59426 appeared on a claim with 59400 or 59510 for the same pregnancy, which reads as billing the antepartum care twice.
How to fix
One structure per pregnancy. If your practice delivered, drop the antepartum line; the global fee includes it.
Source: NCCI
CO-119 Overlapping global claim from the delivering practice
Why it happens
The practice that delivered billed a full global package covering your antepartum span, so the payer sees duplicate payment.
How to fix
The delivering practice corrects to delivery-plus-postpartum components; you resubmit with the transfer date documented on both sides.
Source: CMS
CO-50 Documented count below 7
Why it happens
The payer's review found 6 or fewer routine visits, so the code overstated the bundle.
How to fix
Rebill 59425 for 4 to 6 visits. Keep problem visits out of the count; they have their own E/M claims.
Source: ACOG
CO-151 Billed with multiple units
Why it happens
The claim tried a unit per visit; the code is a single flat bundle regardless of count above 7.
How to fix
Resubmit with a quantity of one.
Source: CMS
CO-16 Unprocessable date or provider fields
Why it happens
A date range where the payer wanted a single date of service, or mismatched provider identifiers across the span.
How to fix
Use the last visit date as the date of service and one consistent billing entity, then resubmit.
Source: CMS

FAQ

What is the CPT code description for 59426?
In plain language, 59426 covers 7 or more routine antepartum visits provided by a practice that does not perform the delivery, billed once as a single flat bundle.
Do I get paid more for 12 visits than for 7?
No. The code pays the same whether the count is 7 or 13. There is no add-on for additional routine visits, which is worth knowing before referring a patient out at 28 weeks.
The patient transferred out at 39 weeks after a full visit schedule. Still 59426?
Yes. If another practice performs the delivery, your ceiling is 59426 no matter how complete your antepartum course was. The delivery is what unlocks global billing.
How do high-risk problem visits interact with the count?
They sit outside it. Visits for hypertension, gestational diabetes, or other distinct problems bill as E/M with their own diagnoses, on top of 59426, and do not count toward the 7.
What if the pregnancy ends in a loss before delivery?
Bill the antepartum code matching your visit count, plus the procedure that managed the loss where one applied, such as 59812 for surgical treatment of an incomplete first-trimester miscarriage.
Can two practices each bill 59426 for one pregnancy?
Yes, when the antepartum span genuinely split and each practice documents its own 7-plus visit count. Payers scrutinize this pattern, so both flow sheets need to stand on their own.
CPT® is a registered trademark of the American Medical Association. Educational reference only, not billing, legal, or medical advice. Maintained by Ouma Health, a maternal-fetal telemedicine practice. Printed from obcodingguide.com, content current as of July 2026.