CPT 59426
Global MMM ActiveAntepartum care only
CPT 59426 Billing & Documentation Guide
CPT code 59426 (Antepartum care only) is classified under Surgery (Urinary/Reproductive) with a global period indicator of MMM. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 14.3, a non-facility practice expense RVU of 13.2, and a malpractice RVU of 4.1, a total non-facility RVU of 31.6 and facility RVU of 21.51. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1064.74, though rates vary from $926.88 to $1286.73 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59426, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 59426 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Maternity codes (separate billing rules)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 59426 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 59426
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 14.3 | 14.3 |
| Practice Expense RVU | 13.2 | 3.11 |
| Malpractice RVU | 4.1 | 4.1 |
| Total RVU | 31.6 | 21.51 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59426
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1090.71 | $691.93 | $1042.37 - $1239.34 | 29 |
| Florida | $1186.58 | $848.44 | $1104.95 - $1282.93 | 3 |
| Georgia | $1062.82 | $741.3 | $1034.15 - $1091.48 | 2 |
| Illinois | $1167.02 | $841.38 | $1094.21 - $1238.36 | 4 |
| Michigan | $1084.38 | $767.92 | $1034.78 - $1133.98 | 2 |
| North Carolina | $976.49 | $662.06 | $976.49 - $976.49 | 1 |
| New York | $1178.32 | $802.35 | $992.75 - $1286.73 | 5 |
| Ohio | $1018.21 | $710.51 | $1018.21 - $1018.21 | 1 |
| Pennsylvania | $1060.18 | $730.07 | $1011.78 - $1108.57 | 2 |
| Texas | $1041.52 | $709.73 | $1006.07 - $1107.69 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 59426
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59426 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 37202 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 59610 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
Frequently Asked Questions, CPT 59426
What does CPT code 59426 mean? +
CPT code 59426 represents: Antepartum care only. It's in the Surgery (Urinary/Reproductive) category with a global period of MMM.
What is the Medicare reimbursement for CPT 59426? +
The 2026 Medicare national average non-facility payment for CPT 59426 is $1064.74. Rates range from $926.88 to $1286.73 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59426? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 59426? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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