What insurance policy changes affect CPT 59426?

There are 22 tracked policy changes affecting CPT 59426, including updates from Blue Cross Blue Shield of Vermont, Florida Blue, Harvard Pilgrim Health Care. 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, Florida Blue, Harvard Pilgrim Health Care, NC Medicaid - NCDHHS, Utah Medicaid, MassHealth, 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 22 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Florida Blue, and 10 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.

High impact

Adaptive Maintenance for October 1, 2026

Blue Cross Blue Shield of Vermont·Effective Oct 1, 2026

Blue Cross and Blue Shield of Vermont is implementing multiple billing and operational changes effective October 1, 2026 and November 1, 2026. Key changes include: (1) mandatory Electronic Fund Transfer (EFT) for all provider payments—paper checks will no longer be issued; (2) systematic enforcement of National Drug Code (NDC) billing rules starting October 30, 2026, which may result in denial of claims previously accepted; (3) updates to medical policies, provider handbook, preventive guide, and codes effective November 1, 2026; and (4) new maternity services coding requirements effective September 1, 2026 using E/M codes with modifier -TH instead of global obstetric codes.

59426 Insurance Policy Changes

Adaptive Maintenance for October 1, 2026

Only 30 Days Left - Don't Miss Your Payments!

Maternity Care Services Global CPT Code Changes

Changes to maternity care coding coming Jan. 1, 2027

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

September 2026 Medicaid Information Bulletin

Prenatal Care and New Obstetric Billing Codes Seminar

Documentation and Coding Training Series

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

Member Rights and Responsibilities

Pharmacy Updates

Changes Coming in January to Global Maternity Care and Delivery Coding

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

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