MedicaidBilling CodesHigh impact
Billing for Antepartum Care
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine·Provider Notice
Effective date
Apr 1, 2004
We identified it
Jun 21, 2026
Summary
Effective April 1, 2004, CPT codes 59420, 59425, and 59426 for antepartum care will no longer be accepted and claims will be rejected. Providers must bill antepartum services separately using appropriate E&M codes with modifier TH for routine prenatal visits, without TH for complications, and specific codes for delivery and postpartum care.
Action Required
Before April 1, 2004: Billing team must update system to reject CPT codes 59420, 59425, and 59426 for antepartum care. Configure billing to use appropriate E&M codes with modifier TH for routine prenatal visits, E&M codes without TH for pregnancy complications, appropriate delivery CPT codes, and CPT 59430 for postpartum care (limit one per delivery). Update encounter forms and train providers on new coding requirements. Claims with rejected codes will be denied.