What insurance policy changes affect CPT 59426?

There are 14 tracked policy changes affecting CPT 59426, including updates from MassHealth, Blue Cross Blue Shield of Vermont, NC Medicaid - NCDHHS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 59426?

Payers that have issued tracked updates for CPT 59426 include: MassHealth, Blue Cross Blue Shield of Vermont, NC Medicaid - NCDHHS, Kansas Medicaid (KanCare), Healthfirst, Oregon Health Plan, Blue Cross of Idaho, New Mexico Medicaid, Blue Cross Blue Shield of Rhode Island.

How do I get notified when CPT 59426 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 59426. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 59426?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

59426 — Medical visits and monitoring during pregnancy before labor begins, without delivery or postpartum care included.: Insurance Policy Changes

59426 Insurance Policy Changes

CPT 59426, in plain terms, covers Medical visits and monitoring during pregnancy before labor begins, without delivery or postpartum care included. CPT 59426 is referenced in 14 tracked payer policy changes from MassHealth, Blue Cross Blue Shield of Vermont, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 59426 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

PAP208 - From and To Dates of Service on a CMS 1500 - Updated first bullet under Service Dates (Box 24A) to not deny claim but to make to and from dates the same if left blank. Updated Exceptions 1. And 2. To include return/deny claims. Moved language from Exceptions 1. To 2. And added a number 3 to separate instances.

Blue Cross of Idaho·Effective Jun 1, 2025

Blue Cross of Idaho updated their CMS 1500 billing policy for Box 24A service dates. If providers leave the 'to' date blank but fill in the 'from' date, the insurer will now automatically make both dates the same instead of denying the claim. The exceptions for specific procedure codes (59425, 59426, 77427) now clearly state claims will be returned/denied if not billed correctly.

59426 Insurance Policy Changes

All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

Changes to Global Maternity Care and Delivery Coding

Global Obstetrics/New Maternity Services Codes

Adaptive Maintenance (new and revised codes) Addition

Member Rights and Responsibilities

Changes Coming in January to Global Maternity Care and Delivery Coding

Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027

KMAP BULLETIN: Billing Guidance for Pregnancy Services Spanning Calendar Years 2026-2027

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy

Billing guidance for obstetric services provided by FQHCs and RHCs

Supplement 25-07: Birthing Options Program Billing & Reimbursement Replaces Supplement 19-02

Hints for HEDIS

PAP304 - Prenatal and Postpartum Care Coding for HEDIS Quality - New