59426
Antepartum care only, high risk, additional visits
Antepartum care only, high risk, additional visits is the #508 most-billed Medicaid procedure code, with $177.1M in payments across 1.4M claims from 2018–2024. The national median cost per claim is $122.30. Costs vary widely — the 90th percentile is $885.02 per claim, 7.2× the median.
Total Paid
$177.1M
0.02% of all spending
Total Claims
1.4M
Providers
858
Avg Cost/Claim
$129
National Cost Distribution
How much do providers bill per claim for 59426? Based on 744 providers billing this code nationally.
Median
$122.30
Average
$392.46
Std Dev
$443.90
Max
$6,904.87
Percentile Distribution (Cost per Claim)
50% of providers bill between $73.19 and $737.79 per claim for this code.
90% bill between $42.54 and $885.02.
Top 1% bill above $1,413.98.
About This Procedure
HCPCS code 59426 (Antepartum care only, high risk, additional visits) was billed by 858 providers across 1.4M claims, totaling $177.1M in Medicaid payments from 2018–2024. This code was used for 799K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$122.30
Providers Billing
744
National Spending
$177.1M
Avg/Median Ratio
3.21×
Highly skewed — outlier-driven
Top Providers Billing This Code
Ranked by total Medicaid payments for 59426
| # | Provider | Total Paid |
|---|---|---|
| 1 | Community Physicians Of Indiana Inc Indianapolis, IN · Internal Medicine | $5.0M |
| 2 | 1093145377 | $3.3M |
| 3 | 1417961137 | $3.3M |
| 4 | 1780634964 | $3.1M |
| 5 | 1316036353 | $3.0M |
| 6 | 1669470019 | $2.8M |
| 7 | 1891803904 | $2.8M |
| 8 | 1982694196 | $2.8M |
| 9 | William Beaumont Hospital Royal Oak, MI · Internal Medicine, Cardiovascular Disease | $2.4M |
| 10 | 1790856235 | $2.3M |
| 11 | 1548640642 | $2.3M |
| 12 | 1073827101 | $2.2M |
| 13 | 1528113032 | $1.9M |
| 14 | 1013953983 | $1.9M |
| 15 | 1568653780 | $1.8M |
| 16 | 1043203136 | $1.8M |
| 17 | 1639104854 | $1.7M |
| 18 | 1720190002 | $1.7M |
| 19 | Spectrum Health Primary Care Partners Grand Rapids, MI · Psychologist, Clinical Child & Adolescent | $1.7M |
| 20 | 1083868269 | $1.6M |
Showing top 20 of 858 providers billing this code