The Record - for physicians and other health care providers to share with their office staffs Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
April 2015

Maternity care billing: Here’s how to report antepartum care for a high-risk condition

When a practitioner is not performing all three components of global maternity care, antepartum visit code 59425 or 59426 should be reported with a quantity of one. Here are the three components of global maternity care:

  • Antepartum visits
  • Delivery
  • Postpartum care 

Note: The code 59425 is used to report four to six visits, while code 59426 is used when there are seven or more visits.

When a practitioner provides the maternity care for a high-risk condition, an appropriate evaluation and management code with modifier 25 should be reported to indicate a significant separately identifiable E&M service was performed. The diagnosis code used in conjunction with the E&M code should support the high-risk condition for post-audit review.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.