Reimbursement Policy Reminder: Antepartum Visit CPT Codes

As a reminder, the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reimbursement policy regarding antepartum, delivery, and postpartum care under routine maternity services was established in 2021. View the full policy here, specifically Section IV.

Providers must ensure that antepartum codes—particularly 59425 and 59426—are billed only once per provider or provider group, based on the billing FTIN. These codes should only be used when the provider does not bill for global maternity services. Duplicate billing for these codes will not be reimbursed.

Blue Cross NC remains committed to working with our OB-GYN providers to uphold proper billing practices, ensuring fair and accurate reimbursement while preventing unnecessary payment errors.

This policy applies to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage, and Federal Employee Program (FEP). This does not apply to IPP Home.