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PAYER POLICY CHANGES

59426 Insurance Policy Changes

CPT 59426, in plain terms, covers Covers prenatal visits only, used when the practice provides 7 or more antepartum visits and handles neither the delivery nor the postpartum care. CPT 59426 is referenced in 40 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, and 24 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.

Official descriptor: CPT 59426 on AAPC

Watch 59426

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Community Health Plan of Imperial Valley · Effective December 31, 2025

    Prior authorization required

    Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 59426?

CalViva Health lists 59426 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 59426?

Community Health Plan of Imperial Valley lists 59426 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 59426?

There are 40 tracked policy changes affecting CPT 59426, including updates from Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, Indiana Medicaid (IHCP). 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: Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, Indiana Medicaid (IHCP), Healthfirst, Harvard Pilgrim Health Care, Alabama Medicaid, Blue Cross and Blue Shield of Kansas City, Utah Medicaid, Nebraska Medicaid, Florida Blue, NC Medicaid - NCDHHS, Highmark, MassHealth, Arkansas Medicaid, Kansas Medicaid (KanCare), NY Medicaid, Oregon Health Plan, SelectHealth, Capital Blue Cross, New Mexico Medicaid, Blue Cross of Idaho, Maryland Medicaid, Colorado Medicaid, L.A. Care Health Plan, Blue Cross Blue Shield of Rhode Island, Aetna.

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 get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

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.

See every payer rule for 59426

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 59426 in one place.

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RELATED

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