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

Reports a course of four to six prenatal care visits when the clinician provides antepartum care but does not bill the complete obstetrical package.

CMS RVU26DEffective Oct 1, 2026One payment locality368 Medicare services in 2024

In North Carolina, Medicare pays $531.87 for 59425 in the office and $361.10 when it’s performed in a hospital or facility.

$531.87Office (non-facility)
$361.10Hospital or facility
−7.5%vs the national office rate ($574.83)

Check a contract rate as a % of Medicare · 59425 nationwide

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

We’ll open 59425 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 59425 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Carolina compares for 59425

Across 109 of 109 payment localities, the office rate for 59425 runs from $504.89 in Arkansas to $700.66 in NYC suburbs and Long Island, NY. North Carolina pays $531.87. The RVUs are the same everywhere; the geographic indexes change the dollars.

59425 in North Carolina vs other payment areas
  1. North Carolina · this page$531.87
  2. Los Angeles, CA · California$604.37+$72.50
  3. Washington, DC area · District of Columbia$640.00+$108.13
  4. Miami, FL · Florida$698.55+$166.68
  5. Chicago, IL · Illinois$674.31+$142.44
  6. Manhattan, NY · New York$674.00+$142.13
  7. Alaska · Alaska$687.24+$155.37

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

59425 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$512.53$352.37
ArkansasArkansas$504.89$347.66
ArizonaArizona$556.67$379.31
Bakersfield, CACalifornia$573.68$373.07
Chico, CACalifornia$567.72$367.11
El Centro, CACalifornia$568.09$367.48
Fresno, CACalifornia$567.72$367.11
Hanford, CACalifornia$567.72$367.11

59425 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$504.89

$687.24

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
59425 office rate range by state
State / territoryOffice rate rangeLocalities
AK$687.241
AL$512.531
AR$504.891
AZ$556.671
CA$567.72–$674.9329
CO$576.991
CT$614.151
DC$640.001
DE$565.731
FL$601.74–$698.553
GA$563.23–$594.422
GU$576.331
HI$576.331
IA$509.531
ID$516.391
IL$595.90–$674.314
IN$519.041
KS$514.861
KY$541.881
LA$544.12–$570.812
MA$576.59–$623.842
MD$574.20–$640.003
ME$527.49–$545.192
MI$563.57–$617.532
MN$529.351
MO$539.80–$563.473
MS$522.051
MT$574.681
NC$531.871
ND$530.591
NE$510.031
NH$575.351
NJ$614.54–$634.682
NM$569.901
NV$562.631
NY$540.72–$700.665
OH$554.561
OK$532.561
OR$551.75–$586.552
PA$551.07–$603.732
PR$576.351
RI$579.651
SC$545.431
SD$525.371
TN$518.521
TX$547.96–$603.248
UT$552.841
VA$548.85–$640.002
VI$576.351
VT$535.641
WA$573.13–$628.662
WI$513.211
WV$575.521
WY$555.461

See 59425 in every payment locality

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.

How the rate is built · 59425

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.80

7.80 RVUs× 1.000 GPCI

Practice expense7.18

7.18 RVUs× 1.000 GPCI

Malpractice2.23

2.23 RVUs× 1.000 GPCI

Adjusted RVUs

17.2100

Conversion factor

$33.4009

Medicare rate

$574.83

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,660

Code
59425
Physician work
7.80
Practice expense
7.18
Malpractice
2.23

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 59425 in North Carolina
ComponentRVULocality factorAdjusted
Physician work7.80× 1.0007.8000
Practice expense7.18× 0.9336.6989
Malpractice2.23× 0.6391.4250
Total RVUs15.9239
Conversion factor× 33.4009

Office rate, North Carolina$531.87

Office: (7.8 × 1 + 7.18 × 0.933 + 2.23 × 0.639) × $33.4009 = $531.87

Facility: (7.8 × 1 + 1.7 × 0.933 + 2.23 × 0.639) × $33.4009 = $361.10

Open 59425 in the RVU calculator

Payment rules and modifiers for 59425

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

CMS payment indicators · 59425

Prenatal care, four to six visits

RuleCMS valueWhat it means
Global periodMMMMaternity care: global rules don’t follow the standard pattern.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 59425

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

Codes related to 59425
CodeHow it relatesOffice range, North Carolina
Same family
59426Prenatal care, seven or more visitsAntepartum-care sibling for a course of seven or more visits.$976.49
Used instead
59400Maternity care, antepartum, delivery, postpartumBroader obstetrical package when the clinician provides antepartum care, vaginal delivery, and postpartum care.No office rate
59410Vaginal delivery, postpartum care includedVaginal delivery with postpartum care in a delivery-focused reporting arrangement.No office rate

How 59425 has changed in North Carolina

59425 · Office / nonfacility

$531.87

Effective 2026-10-01

The base rate is $23.10 higher than on 2025-10-01, moving from $508.77 to $531.87 (4.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $508.77changed to$531.87

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 7.04 changed to 7.18
    • Malpractice RVU 2.12 changed to 2.23
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $524.55changed to$508.77

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.05 changed to 7.04
    • Malpractice RVU 2.15 changed to 2.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $515.98changed to$524.55

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $535.76changed to$515.98

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.96 changed to 7.05
    • Malpractice RVU 2.10 changed to 2.15
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $545.60changed to$535.76

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.81 changed to 6.96
    • Malpractice RVU 2.01 changed to 2.10
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $542.86changed to$545.60

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.63 changed to 6.81
    • Malpractice RVU 1.96 changed to 2.01

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $459.79changed to$542.86

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 6.31 changed to 7.80
    • Practice expense RVU 5.62 changed to 6.63
    • Malpractice RVU 1.59 changed to 1.96
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $445.49changed to$459.79

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.41 changed to 5.62
    • Malpractice RVU 1.46 changed to 1.59
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $439.47changed to$445.49

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.23 changed to 5.41
    • Malpractice RVU 1.48 changed to 1.46

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $442.09changed to$439.47

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.29 changed to 5.23
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $441.77changed to$442.09

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.26 changed to 5.29
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $446.06changed to$441.77

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.25 changed to 5.26
    • Malpractice RVU 1.59 changed to 1.48

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $443.85changed to$446.06

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $443.95changed to$443.85

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.24 changed to 5.25
    • Malpractice RVU 1.66 changed to 1.59
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $437.18changed to$443.95

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.75 changed to 5.24
    • Malpractice RVU 1.74 changed to 1.66
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $437.18

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$531.87$361.10RVU26D
2026-07-01$531.87$361.10RVU26C
2026-04-01$531.87$361.10RVU26B
2026-01-01$531.87$361.10RVU26A
2025-10-01$508.77$390.76RVU25D
2025-07-01$508.77$390.76RVU25C
2025-04-01$508.77$390.76RVU25B
2025-01-01$508.77$390.76RVU25A
2024-10-01$524.55$401.87RVU24D
2024-07-01$524.55$401.87RVU24C
2024-04-01$524.55$401.87RVU24B
2024-03-09$524.55$401.87RVU24AR
2024-01-01$515.98$395.31RVU24A
2023-10-01$535.76$413.88RVU23D
2023-07-01$535.76$413.88RVU23C
2023-04-01$535.76$413.88RVU23B
2023-01-01$535.76$413.88RVU23A
2022-10-01$545.60$423.88RVU22D
2022-07-01$545.60$423.88RVU22C
2022-04-01$545.60$423.88RVU22B
2022-01-01$545.60$423.88RVU22A
2021-10-01$542.86$426.94RVU21D
2021-07-01$542.86$426.94RVU21C
2021-04-01$542.86$426.94RVU21B
2021-01-01$542.86$426.94RVU21A
2020-10-01$459.79$352.72RVU20D
2020-07-01$459.79$352.72RVU20C
2020-04-01$459.79$352.72RVU20B
2020-01-01$459.79$352.72RVU20A
2019-10-01$445.49$345.51RVU19D
2019-07-01$445.49$345.51RVU19C
2019-04-01$445.49$345.51RVU19B
2019-01-01$445.49$345.51RVU19A
2018-10-01$439.47$346.97RVU18D
2018-07-01$439.47$346.97RVU18C
2018-04-01$439.47$346.97RVU18B
2018-01-01$439.47$346.97RVU18AR1
2017-10-01$442.09$349.54RVU17D
2017-07-01$442.09$349.54RVU17C
2017-04-01$442.09$349.54RVU17B
2017-01-01$442.09$349.54RVU17A
2016-10-01$441.77$349.53RVU16D
2016-07-01$441.77$349.53RVU16C
2016-04-01$441.77$349.53RVU16B
2016-01-01$441.77$349.53RVU16A
2015-10-01$446.06$354.16RVU15D
2015-07-01$446.06$354.16RVU15C
2015-04-01$443.85$352.40RVU15B
2015-01-01$443.85$352.40RVU15A
2014-10-01$443.95$353.10RVU14D
2014-07-01$443.95$353.10RVU14C
2014-04-01$443.95$353.10RVU14B
2014-01-01$443.95$353.10RVU14A
2013-10-01$437.18$340.99RVU13D
2013-07-01$437.18$340.99RVU13C
2013-04-01$437.18$340.99RVU13B
2013-01-01$437.18$340.99RVU13AR

Price 59425 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

59425 billing questions

How many prenatal visits support 59425?

Use it for four to six antepartum visits. Seven or more visits fall under 59426.

Should 59425 be billed once per visit?

No. It represents a course of four to six antepartum visits, rather than an individual prenatal encounter. Document the visits included in that course.

How does 59425 differ from 59400?

59425 covers antepartum care only. 59400 represents a broader obstetrical package that includes antepartum care, vaginal delivery, and postpartum care.

Does 59425 have a standard surgical global period?

No. CMS identifies it as a maternity code, for which the usual global surgery rules do not apply.

What documentation supports reporting 59425?

Record the dates and number of antepartum visits and the prenatal care provided. The documented count should support four through six visits.

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

Show the CMS file lines behind this rate
RVUs for 59425PPRRVU2026_Oct_nonQPP.csv, line 6,660 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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