CPT code 59426: Prenatal care, seven or more visits2026 Medicare rate & RVUs in California
Report 59426 for a course of antepartum care involving seven or more prenatal visits when the billing clinician does not provide the full maternity package.
Medicare pays $1,042.37–$1,239.34 for 59426 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 59426 covers
CPT 59426 represents antepartum care furnished over seven or more prenatal visits, such as routine prenatal assessment, pregnancy monitoring, and counseling. Obstetricians, family physicians, and other clinicians providing maternity care may furnish these services in an office or clinic. The code covers the prenatal-care portion of the pregnancy; it does not include delivery or postpartum care. It may be relevant when care ends with a transfer before delivery or when another clinician handles the delivery and postpartum period.
Select 59426 based on the number of antepartum visits represented by the course of care: seven or more visits qualify, while four through six visits are reported with 59425. Keep documentation showing the dates and count of visits and the prenatal services furnished. Do not separately report the routine prenatal visits represented by this care package. CMS identifies this as a maternity service outside the usual global-surgery-period framework; it is not paid under the standard surgical global-period approach.
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 59426 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$1042.37 to $1239.34
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $1,053.32 | $683.96 |
| Chico, CA | $1,042.37 | $673.00 |
| El Centro, CA | $1,043.06 | $673.69 |
| Fresno, CA | $1,042.37 | $673.00 |
| Hanford, CA | $1,042.37 | $673.00 |
| Los Angeles, CA | $1,109.72 | $711.03 |
| Madera, CA | $1,042.37 | $673.00 |
| Marin County, CA | $1,207.52 | $732.33 |
| Merced, CA | $1,042.37 | $673.00 |
| Modesto, CA | $1,042.37 | $673.00 |
| Napa, CA | $1,158.39 | $714.20 |
| Oxnard, CA | $1,097.46 | $699.10 |
| Redding, CA | $1,042.37 | $673.00 |
| Rest of California | $1,042.37 | $673.00 |
| Riverside, CA | $1,086.26 | $716.89 |
| Sacramento, CA | $1,080.99 | $689.04 |
| Salinas, CA | $1,076.83 | $686.23 |
| San Benito County, CA | $1,239.34 | $753.36 |
| San Diego, CA | $1,093.49 | $690.42 |
| San Francisco, CA | $1,202.87 | $727.68 |
| San Luis Obispo, CA | $1,061.33 | $677.47 |
| Santa Clara County, CA | $1,220.31 | $734.33 |
| Santa Cruz, CA | $1,096.75 | $687.28 |
| Santa Maria, CA | $1,078.49 | $685.53 |
| Santa Rosa, CA | $1,106.78 | $692.92 |
| Stockton, CA | $1,042.37 | $673.00 |
| Vallejo, CA | $1,151.68 | $707.49 |
| Visalia, CA | $1,042.37 | $673.00 |
| Yuba City, CA | $1,042.37 | $673.00 |
How the 59426 rate is calculated
Each of 59426’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 · 59426
RVUs × geographic indexes × conversion factor
Work14.30
14.30 RVUs× 1.000 GPCI
Practice expense13.20
13.20 RVUs× 1.000 GPCI
Malpractice4.10
4.10 RVUs× 1.000 GPCI
Adjusted RVUs
31.6000
Conversion factor
$33.4009
Medicare rate
$1,055.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 59426
The CMS indicators that decide how 59426 is paid alongside other services.
CMS payment indicators · 59426
Prenatal care, seven or more visits
| Rule | CMS value | What it means |
|---|---|---|
| Global period | MMM | Maternity care: global rules don’t follow the standard pattern. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
59426 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 59425Prenatal careFour to six visits
- Choose 59425 for four through six antepartum visits; 59426 is for seven or more.
- 59400Maternity careAntepartum, delivery, postpartum
- 59400 covers a full maternity package including antepartum care, delivery, and postpartum care. 59426 covers the prenatal portion only.
- 59409Vaginal deliveryDelivery only
- 59409 represents vaginal delivery care. Use 59426 for qualifying antepartum care, not for the delivery service.
59426 billing questions
How many visits qualify for 59426?
Use 59426 for seven or more antepartum visits. Four through six visits fall under 59425.
Does 59426 include delivery or postpartum care?
No. It represents antepartum care only; delivery and postpartum services are outside this code.
Can I also bill each prenatal visit separately?
Do not report the routine prenatal visits represented by the 59426 care package again as separate visit services.
What documentation supports 59426?
Record the dates and number of antepartum visits and the prenatal care furnished. The visit count distinguishes 59426 from 59425.
Does the usual surgical global period apply?
CMS treats 59426 as a maternity service outside the usual global-surgery-period framework.
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
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