How to Bill Antepartum Care Services to Aetna, BCBS, Cigna, and UHC
When it comes to billing antepartum services, accuracy is key — especially since policies can vary by payer. Many practices struggle with getting reimbursed correctly for prenatal care, and bundling or unbundling services incorrectly can result in denials or underpayments.
Below is a breakdown of how to bill antepartum services to major commercial payers: Aetna, Blue Cross Blue Shield (BCBS), Cigna, and UnitedHealthcare (UHC) — along with key tips for success.
Understanding Antepartum Care
Antepartum care typically includes:
-
Initial prenatal history and physical exam
-
Regular prenatal visits (monthly, biweekly, or weekly as pregnancy progresses)
-
Routine labs and screenings (e.g., urinalysis, glucose screening)
-
Counseling and risk assessments
Billing can either be done globally, bundled, or unbundled, depending on the payer and circumstances.
🔹 CPT Codes for Antepartum Care
-
59425 – 4-6 antepartum visits
-
59426 – 7 or more visits
-
59400/59510 – Global OB package (antepartum + delivery + postpartum)
-
99211–99215 – If visits are billed separately (non-global)
Make sure documentation supports the number of visits if you’re billing 59425 or 59426.
🔹 Aetna
Aetna typically follows ACOG guidelines and allows global maternity billing after delivery, but they also accept unbundled billing in certain situations.
Tips:
-
Submit global maternity code (59400/59510) after delivery, unless you’re transferring care.
-
Use 59425 or 59426 if you provided only partial antepartum care (not delivery).
-
If care is discontinued, use 99213/99214 for each visit with appropriate documentation.
-
Always document gestational age and pregnancy status with ICD-10 codes (e.g., Z34.01–Z34.93).
🔹 Blue Cross Blue Shield (BCBS)
BCBS plans vary by state, but many follow similar guidelines.
Tips:
-
NC-BCBS often prefers unbundled billing if fewer than 7 visits are rendered.
-
Use 59425 (4–6 visits) or 59426 (7+ visits) if not billing globally.
-
If patient changes providers mid-care, submit documentation and use a date range with the appropriate code.
-
Don’t forget modifiers like TH (obstetrical treatment/services) when applicable.
🔹 Cigna
Cigna generally follows global maternity billing practices but reimburses partial care as well.
Tips:
-
Use 59400/59510 for global billing after delivery.
-
Use 59425/59426 for partial antepartum care.
-
If patient transfers out or delivery is not performed, Cigna expects appropriate unbundling with E/M codes for each visit.
-
Attach prenatal records if billed outside of global.
🔹 UnitedHealthcare (UHC)
UHC supports global billing and partial billing for antepartum care, similar to other payers.
Tips:
-
Submit 59400/59510 if full care is provided.
-
Submit 59425/59426 based on the number of visits if delivery was not performed.
-
UHC often requires medical notes for unbundled services — especially if there is a gap or transfer of care.
-
Use Z codes to support routine care (e.g., Z34.XX), and O codes if complications arise.
âś… Pro Tips for All Payers:
-
Track visits carefully: Keep a running count to determine the correct code (59425 or 59426).
-
Document everything: Payers want clear justification for what you’re billing.
-
Know when global applies: Only bill globally if your provider delivers and manages the entire prenatal course.
-
Include date range of services on claim lines for antepartum codes.
-
Use modifiers appropriately (e.g., TH, 25, 24, etc.).
Final Thoughts
Correct billing for antepartum services requires attention to payer policies, visit counts, and documentation. Submitting the wrong code or billing too early for global maternity services can delay payment or lead to denials.
If your billing team is overwhelmed or you’re unsure whether you’re capturing everything correctly, outsourcing can be a smart solution. At Resurgence Medical Management, we help OB/GYN practices like yours navigate complex payer rules and get paid faster, with fewer denials.
Need help with your OB billing?
👉 Contact us for a free consultation