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

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 Puerto Rico, Medicare pays $576.35 for 59425 in the office and $391.30 when it’s performed in a hospital or facility.

$576.35Office (non-facility)
$391.30Hospital or facility
+0.3%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $576.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

59425 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$576.35
  2. Los Angeles, CA · California$604.37+$28.02
  3. Washington, DC area · District of Columbia$640.00+$63.65
  4. Miami, FL · Florida$698.55+$122.20
  5. Chicago, IL · Illinois$674.31+$97.96
  6. Manhattan, NY · New York$674.00+$97.65
  7. Alaska · Alaska$687.24+$110.89

Other areas in Puerto Rico 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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 59425 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work7.80× 1.0007.8000
Practice expense7.18× 1.0117.2590
Malpractice2.23× 0.9852.1965
Total RVUs17.2555
Conversion factor× 33.4009

Office rate, Puerto Rico$576.35

Office: (7.8 × 1 + 7.18 × 1.011 + 2.23 × 0.985) × $33.4009 = $576.35

Facility: (7.8 × 1 + 1.7 × 1.011 + 2.23 × 0.985) × $33.4009 = $391.30

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, Puerto Rico
Same family
59426Prenatal care, seven or more visitsAntepartum-care sibling for a course of seven or more visits.$1,058.26
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 Puerto Rico

59425 · Office / nonfacility

$576.35

Effective 2026-10-01

The base rate is $27.39 higher than on 2025-10-01, moving from $548.96 to $576.35 (5.0%).

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

    $548.96changed to$576.35

    • 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 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $566.24changed to$548.96

    • 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

    $557.00changed to$566.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $572.09changed to$557.00

    • 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 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $571.34changed to$572.09

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $576.07changed to$571.34

    • 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 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $572.79changed to$576.07

    • 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.

  8. January 1, 2021

    RVU21A

    $488.87changed to$572.79

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $475.83changed to$488.87

    • 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 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $469.50changed to$475.83

    • 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.

  11. January 1, 2018

    RVU18AR1

    $423.07changed to$469.50

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.29 changed to 5.23
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $374.22changed to$423.07

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.26 changed to 5.29
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $376.48changed to$374.22

    • 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.

  14. July 1, 2015

    RVU15C

    $374.61changed to$376.48

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $372.05changed to$374.61

    • 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 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $362.06changed to$372.05

    • 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 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $362.06

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$576.35$391.30RVU26D
2026-07-01$576.35$391.30RVU26C
2026-04-01$576.35$391.30RVU26B
2026-01-01$576.35$391.30RVU26A
2025-10-01$548.96$420.62RVU25D
2025-07-01$548.96$420.62RVU25C
2025-04-01$548.96$420.62RVU25B
2025-01-01$548.96$420.62RVU25A
2024-10-01$566.24$432.83RVU24D
2024-07-01$566.24$432.83RVU24C
2024-04-01$566.24$432.83RVU24B
2024-03-09$566.24$432.83RVU24AR
2024-01-01$557.00$425.77RVU24A
2023-10-01$572.09$439.55RVU23D
2023-07-01$571.34$439.86RVU23C
2023-04-01$571.34$439.86RVU23B
2023-01-01$571.34$439.86RVU23A
2022-10-01$576.07$443.86RVU22D
2022-07-01$576.07$443.86RVU22C
2022-04-01$576.07$443.86RVU22B
2022-01-01$576.07$443.86RVU22A
2021-10-01$572.79$446.87RVU21D
2021-07-01$572.79$446.87RVU21C
2021-04-01$572.79$446.87RVU21B
2021-01-01$572.79$446.87RVU21A
2020-10-01$488.87$372.82RVU20D
2020-07-01$488.87$372.82RVU20C
2020-04-01$488.87$372.82RVU20B
2020-01-01$488.87$372.82RVU20A
2019-10-01$475.83$367.69RVU19D
2019-07-01$475.83$367.69RVU19C
2019-04-01$475.83$367.69RVU19B
2019-01-01$475.83$367.69RVU19A
2018-10-01$469.50$369.45RVU18D
2018-07-01$469.50$369.45RVU18C
2018-04-01$469.50$369.45RVU18B
2018-01-01$469.50$369.45RVU18AR1
2017-10-01$423.07$337.97RVU17D
2017-07-01$423.07$337.97RVU17C
2017-04-01$423.07$337.97RVU17B
2017-01-01$423.07$337.97RVU17A
2016-10-01$374.22$304.30RVU16D
2016-07-01$374.22$304.30RVU16C
2016-04-01$374.22$304.30RVU16B
2016-01-01$374.22$304.30RVU16A
2015-10-01$376.48$306.81RVU15D
2015-07-01$376.48$306.81RVU15C
2015-04-01$374.61$305.29RVU15B
2015-01-01$374.61$305.29RVU15A
2014-10-01$372.05$304.38RVU14D
2014-07-01$372.05$304.38RVU14C
2014-04-01$372.05$304.38RVU14B
2014-01-01$372.05$304.38RVU14A
2013-10-01$362.06$291.71RVU13D
2013-07-01$362.06$291.71RVU13C
2013-04-01$362.06$291.71RVU13B
2013-01-01$362.06$291.71RVU13AR

Price 59425 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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