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CPT code 59426: Prenatal care, seven or more visits2026 Medicare rate & RVUs in Puerto Rico

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.

CMS RVU26DEffective Oct 1, 2026One payment locality395 Medicare services in 2024

In Puerto Rico, Medicare pays $1,058.26 for 59426 in the office and $717.54 when it’s performed in a hospital or facility.

$1,058.26Office (non-facility)
$717.54Hospital or facility
+0.3%vs the national office rate ($1,055.47)

Check a contract rate as a % of Medicare · 59426 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 59426 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 59426 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 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.

How Puerto Rico compares for 59426

Across 109 of 109 payment localities, the office rate for 59426 runs from $926.88 in Arkansas to $1,286.73 in NYC suburbs and Long Island, NY. Puerto Rico pays $1,058.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

59426 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$1,058.26
  2. Los Angeles, CA · California$1,109.72+$51.46
  3. Washington, DC area · District of Columbia$1,175.21+$116.95
  4. Miami, FL · Florida$1,282.93+$224.67
  5. Chicago, IL · Illinois$1,238.36+$180.10
  6. Manhattan, NY · New York$1,237.71+$179.45
  7. Alaska · Alaska$1,261.46+$203.20

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

59426 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$940.92$646.04
ArkansasArkansas$926.88$637.39
ArizonaArizona$1,022.08$695.51
Bakersfield, CACalifornia$1,053.32$683.96
Chico, CACalifornia$1,042.37$673.00
El Centro, CACalifornia$1,043.06$673.69
Fresno, CACalifornia$1,042.37$673.00
Hanford, CACalifornia$1,042.37$673.00

59426 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.

$926.88

$1,261.46

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

View every state and territory as a table
59426 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,261.461
AL$940.921
AR$926.881
AZ$1,022.081
CA$1,042.37–$1,239.3429
CO$1,059.431
CT$1,127.731
DC$1,175.211
DE$1,038.731
FL$1,104.95–$1,282.933
GA$1,034.15–$1,091.482
GU$1,058.221
HI$1,058.221
IA$935.421
ID$948.031
IL$1,094.21–$1,238.364
IN$952.891
KS$945.221
KY$994.891
LA$999.01–$1,048.082
MA$1,058.68–$1,145.522
MD$1,054.31–$1,175.213
ME$968.43–$1,000.972
MI$1,034.78–$1,133.982
MN$971.851
MO$991.06–$1,034.583
MS$958.441
MT$1,055.191
NC$976.491
ND$974.121
NE$936.341
NH$1,056.431
NJ$1,128.42–$1,165.412
NM$1,046.401
NV$1,033.041
NY$992.75–$1,286.735
OH$1,018.211
OK$977.751
OR$1,013.03–$1,076.992
PA$1,011.78–$1,108.572
PR$1,058.261
RI$1,064.301
SC$1,001.421
SD$964.541
TN$951.941
TX$1,006.07–$1,107.698
UT$1,015.051
VA$1,007.71–$1,175.212
VI$1,058.261
VT$983.411
WA$1,052.32–$1,154.372
WI$942.191
WV$1,056.731
WY$1,019.861

See 59426 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,661

Code
59426
Physician work
14.30
Practice expense
13.20
Malpractice
4.10

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 59426 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work14.30× 1.00014.3000
Practice expense13.20× 1.01113.3452
Malpractice4.10× 0.9854.0385
Total RVUs31.6837
Conversion factor× 33.4009

Office rate, Puerto Rico$1058.26

Office: (14.3 × 1 + 13.2 × 1.011 + 4.1 × 0.985) × $33.4009 = $1058.26

Facility: (14.3 × 1 + 3.11 × 1.011 + 4.1 × 0.985) × $33.4009 = $717.54

Open 59426 in the RVU calculator

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

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 59426

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

Codes related to 59426
CodeHow it relatesOffice range, Puerto Rico
Same family
59425Prenatal care, four to six visitsAntepartum care code for four through six visits.$576.35
Used instead
59400Maternity care, antepartum, delivery, postpartumUsed for the full maternity package when antepartum, delivery, and postpartum care are furnished.No office rate
59409Vaginal delivery, delivery onlyRepresents vaginal delivery care rather than a course of antepartum visits.No office rate
59410Vaginal delivery, postpartum care includedRepresents vaginal delivery with postpartum care, not antepartum care alone.No office rate

How 59426 has changed in Puerto Rico

59426 · Office / nonfacility

$1058.26

Effective 2026-10-01

The base rate is $53.32 higher than on 2025-10-01, moving from $1004.94 to $1058.26 (5.3%).

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

    $1004.94changed to$1058.26

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 12.78 changed to 13.20
    • Malpractice RVU 3.97 changed to 4.10
    • 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

    $1035.84changed to$1004.94

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 12.82 changed to 12.78
    • Malpractice RVU 3.98 changed to 3.97

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1018.94changed to$1035.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1047.10changed to$1018.94

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 12.69 changed to 12.82
    • Malpractice RVU 3.87 changed to 3.98
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $1045.76changed to$1047.10

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

  6. January 1, 2023

    RVU23A

    $1052.33changed to$1045.76

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 12.43 changed to 12.69
    • Malpractice RVU 3.63 changed to 3.87
    • 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

    $1048.10changed to$1052.33

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 12.14 changed to 12.43
    • Malpractice RVU 3.55 changed to 3.63

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $870.06changed to$1048.10

    • Conversion factor 36.0896 changed to 34.8931
    • Work RVU 11.16 changed to 14.30
    • Practice expense RVU 10.16 changed to 12.14
    • Malpractice RVU 2.74 changed to 3.55
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $849.22changed to$870.06

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.85 changed to 10.16
    • Malpractice RVU 2.51 changed to 2.74
    • 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

    $839.24changed to$849.22

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.63 changed to 9.85
    • Malpractice RVU 2.48 changed to 2.51

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $757.65changed to$839.24

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.72 changed to 9.63
    • Malpractice RVU 2.54 changed to 2.48
    • 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

    $669.16changed to$757.65

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.62 changed to 9.72
    • Malpractice RVU 2.55 changed to 2.54
    • 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

    $674.18changed to$669.16

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.64 changed to 9.62
    • Malpractice RVU 2.75 changed to 2.55

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $670.83changed to$674.18

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $665.47changed to$670.83

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.59 changed to 9.64
    • Malpractice RVU 2.88 changed to 2.75
    • 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

    $647.87changed to$665.47

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.52 changed to 9.59
    • Malpractice RVU 3.01 changed to 2.88
    • 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: $647.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,058.26$717.54RVU26D
2026-07-01$1,058.26$717.54RVU26C
2026-04-01$1,058.26$717.54RVU26B
2026-01-01$1,058.26$717.54RVU26A
2025-10-01$1,004.94$772.37RVU25D
2025-07-01$1,004.94$772.37RVU25C
2025-04-01$1,004.94$772.37RVU25B
2025-01-01$1,004.94$772.37RVU25A
2024-10-01$1,035.84$794.83RVU24D
2024-07-01$1,035.84$794.83RVU24C
2024-04-01$1,035.84$794.83RVU24B
2024-03-09$1,035.84$794.83RVU24AR
2024-01-01$1,018.94$781.86RVU24A
2023-10-01$1,047.10$807.31RVU23D
2023-07-01$1,045.76$807.87RVU23C
2023-04-01$1,045.76$807.87RVU23B
2023-01-01$1,045.76$807.87RVU23A
2022-10-01$1,052.33$813.03RVU22D
2022-07-01$1,052.33$813.03RVU22C
2022-04-01$1,052.33$813.03RVU22B
2022-01-01$1,052.33$813.03RVU22A
2021-10-01$1,048.10$818.78RVU21D
2021-07-01$1,048.10$818.78RVU21C
2021-04-01$1,048.10$818.78RVU21B
2021-01-01$1,048.10$818.78RVU21A
2020-10-01$870.06$657.25RVU20D
2020-07-01$870.06$657.25RVU20C
2020-04-01$870.06$657.25RVU20B
2020-01-01$870.06$657.25RVU20A
2019-10-01$849.22$648.53RVU19D
2019-07-01$849.22$648.53RVU19C
2019-04-01$849.22$648.53RVU19B
2019-01-01$849.22$648.53RVU19A
2018-10-01$839.24$649.29RVU18D
2018-07-01$839.24$649.29RVU18C
2018-04-01$839.24$649.29RVU18B
2018-01-01$839.24$649.29RVU18AR1
2017-10-01$757.65$597.28RVU17D
2017-07-01$757.65$597.28RVU17C
2017-04-01$757.65$597.28RVU17B
2017-01-01$757.65$597.28RVU17A
2016-10-01$669.16$537.90RVU16D
2016-07-01$669.16$537.90RVU16C
2016-04-01$669.16$537.90RVU16B
2016-01-01$669.16$537.90RVU16A
2015-10-01$674.18$541.94RVU15D
2015-07-01$674.18$541.94RVU15C
2015-04-01$670.83$539.25RVU15B
2015-01-01$670.83$539.25RVU15A
2014-10-01$665.47$538.05RVU14D
2014-07-01$665.47$538.05RVU14C
2014-04-01$665.47$538.05RVU14B
2014-01-01$665.47$538.05RVU14A
2013-10-01$647.87$515.46RVU13D
2013-07-01$647.87$515.46RVU13C
2013-04-01$647.87$515.46RVU13B
2013-01-01$647.87$515.46RVU13AR

Price 59426 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

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

Show the CMS file lines behind this rate
RVUs for 59426PPRRVU2026_Oct_nonQPP.csv, line 6,661 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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