CPT code 59425: Prenatal care, four to six visits2026 Medicare rate & RVUs

Medicare pays $574.83 for 59425 nationally in the office and $391.79 in a hospital or facility. Local office rates run $504.89–$700.66.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 59425 covers

This code represents routine prenatal care across four to six visits, such as monitoring maternal and fetal status, assessing pregnancy progress, and managing common prenatal concerns. Obstetricians and other clinicians providing pregnancy care may report it in office or other outpatient settings when their services cover the antepartum portion rather than the full obstetrical package.

Select the code based on the documented number of antepartum visits: four through six, rather than seven or more. Keep records supporting the visit count and the prenatal care provided. The code is reported for the antepartum care course, not once for each visit. CMS classifies it as a maternity code, so the usual global surgery rules do not apply; it is not assigned a standard surgical global period.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 59425 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

59425 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 59425 rate is calculated

Each of 59425’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 59425

The CMS indicators that decide how 59425 is paid alongside other services.

59425 compared with similar codes

How to choose

59426Prenatal careSeven or more visits

Both report antepartum care only; choose 59425 for four to six visits and 59426 for seven or more.

59400Maternity careAntepartum, delivery, postpartum

59425 is limited to antepartum care. 59400 covers antepartum care, vaginal delivery, and postpartum care as an obstetrical package.

59409Vaginal deliveryDelivery only

59409 reports vaginal delivery only. It does not represent a course of prenatal visits.

59410Vaginal deliveryPostpartum care included

59410 reports vaginal delivery with postpartum care; 59425 reports prenatal care only.

Codes related to 59425

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates