Who is affected by this change?

This affects Illinois Medicaid - HFS OB-GYN, Family Medicine providers in IL on Medicaid plans.

When does this change take effect?

This change is effective Apr 1, 2004.

Which billing codes are affected?

The following codes are affected: 59420, 59425, 59426.

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MedicaidBilling CodesMedium impact

Billing for Antepartum Care and Delivery Services

Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine·Provider Notice

Effective date

Apr 1, 2004

We identified it

Jun 21, 2026

Days to comply

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Summary

This policy clarifies billing rules for antepartum care and delivery services. Providers cannot bill separately for individual antepartum visit components when using global care codes, as these components are included in the global payment.

Action Required

Action needed

Review current billing practices for antepartum and delivery services to ensure compliance with bundled payment rules. Stop billing separately for antepartum visit components (physical exams, weight monitoring, blood pressure checks, fetal heart tones, urinalysis) when using global maternity codes or E/M codes with TH modifier for dates of service after April 1, 2004.

Affected Billing Codes

59420

59425

59426

Related policy hubs

Illinois Medicaid - HFS policies IL policy changes OB-GYN Family Medicine Code 59420 Code 59425 Code 59426