Billing code 59426: Prenatal careMedicare rate & RVUs
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 $1,055.47 for 59426 nationally in the office and $718.45 in a hospital or facility. Local office rates run $926.88–$1,286.73.
Medicare rate · 59426
Prenatal care
Swap in your local Medicare rate.
- Work RVUs
- 14.3
- Total RVUs
- 31.60
- Global days
- MMM
National rate · 2026
$1,055.47
Office setting, before claim adjustments.
See every locality for 59426 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 59426 covers
billing code 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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$926.88 to $1286.73
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $940.92 | $646.04 |
| Alaska* | $1,261.46 | $902.53 |
| Arizona | $1,022.08 | $695.51 |
| Arkansas | $926.88 | $637.39 |
| Atlanta | $1,091.48 | $749.07 |
| Austin | $1,066.38 | $709.82 |
| Bakersfield | $1,053.32 | $683.96 |
| Baltimore/Surr. Cntys | $1,127.75 | $766.13 |
| Beaumont | $1,006.07 | $699.38 |
| Brazoria | $1,025.19 | $691.21 |
| Chicago | $1,238.36 | $899.66 |
| Chico | $1,042.37 | $673.00 |
| Colorado | $1,059.43 | $700.84 |
| Connecticut | $1,127.73 | $764.76 |
| Dallas | $1,038.56 | $702.89 |
| Dc + Md/Va Suburbs | $1,175.21 | $778.21 |
| Delaware | $1,038.73 | $705.76 |
| Detroit | $1,133.98 | $808.76 |
| East St. Louis | $1,159.06 | $849.00 |
| El Centro | $1,043.06 | $673.69 |
| Fort Lauderdale | $1,171.85 | $830.45 |
| Fort Worth | $1,035.93 | $703.63 |
| Fresno | $1,042.37 | $673.00 |
| Galveston | $1,032.65 | $697.99 |
| Hanford-Corcoran | $1,042.37 | $673.00 |
| Hawaii, Guam | $1,058.22 | $675.03 |
| Houston | $1,107.69 | $773.04 |
| Idaho | $948.03 | $637.97 |
| Indiana | $952.89 | $640.48 |
| Iowa | $935.42 | $627.05 |
| Kansas | $945.22 | $640.56 |
| Kentucky | $994.89 | $695.28 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $1,109.72 | $711.03 |
| Madera | $1,042.37 | $673.00 |
| Manhattan | $1,237.71 | $846.10 |
| Merced | $1,042.37 | $673.00 |
| Metropolitan Boston | $1,145.52 | $743.12 |
| Metropolitan Kansas City | $1,025.42 | $708.97 |
| Metropolitan Philadelphia | $1,108.57 | $757.74 |
| Metropolitan St. Louis | $1,034.58 | $713.74 |
| Miami | $1,282.93 | $932.10 |
| Minnesota | $971.85 | $625.06 |
| Mississippi | $958.44 | $668.27 |
| Modesto | $1,042.37 | $673.00 |
| Montana** | $1,055.19 | $718.18 |
| Napa | $1,158.39 | $714.20 |
| Nebraska | $936.34 | $625.28 |
| Nevada** | $1,033.04 | $695.69 |
| New Hampshire | $1,056.43 | $705.59 |
| New Mexico | $1,046.40 | $737.36 |
| New Orleans | $1,048.08 | $730.95 |
| North Carolina | $976.49 | $662.06 |
| North Dakota** | $974.12 | $637.11 |
| Northern Nj | $1,165.41 | $774.48 |
| Nyc Suburbs/Long Island | $1,286.73 | $886.02 |
| Ohio | $1,018.21 | $710.51 |
| Oklahoma | $977.75 | $676.80 |
| Oxnard-Thousand Oaks-Ventura | $1,097.46 | $699.10 |
| Portland | $1,076.99 | $702.57 |
| Poughkpsie/N Nyc Suburbs | $1,147.60 | $778.57 |
| Puerto Rico | $1,058.26 | $717.54 |
| Queens | $1,226.81 | $828.46 |
| Redding | $1,042.37 | $673.00 |
| Rest Of California | $1,042.37 | $673.00 |
| Rest Of Florida | $1,104.95 | $782.77 |
| Rest Of Georgia | $1,034.15 | $733.53 |
| Rest Of Illinois | $1,094.21 | $786.52 |
| Rest Of Louisiana | $999.01 | $700.76 |
| Rest Of Maine | $968.43 | $658.38 |
| Rest Of Maryland | $1,054.31 | $713.25 |
| Rest Of Massachusetts | $1,058.68 | $703.80 |
| Rest Of Michigan | $1,034.78 | $727.08 |
| Rest Of Missouri | $991.06 | $700.56 |
| Rest Of New Jersey | $1,128.42 | $760.40 |
| Rest Of New York | $992.75 | $672.59 |
| Rest Of Oregon | $1,013.03 | $677.37 |
| Rest Of Pennsylvania | $1,011.78 | $702.40 |
| Rest Of Texas | $1,019.70 | $699.87 |
| Rest Of Washington | $1,052.32 | $697.44 |
| Rhode Island | $1,064.30 | $716.17 |
| Riverside-San Bernardino-Ontario | $1,086.26 | $716.89 |
| Sacramento-Roseville-Folsom | $1,080.99 | $689.04 |
| Salinas | $1,076.83 | $686.23 |
| San Diego-Chula Vista-Carlsbad | $1,093.49 | $690.42 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $1,207.52 | $732.33 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $1,202.87 | $727.68 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,239.34 | $753.36 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,220.31 | $734.33 |
| San Luis Obispo-Paso Robles | $1,061.33 | $677.47 |
| Santa Cruz-Watsonville | $1,096.75 | $687.28 |
| Santa Maria-Santa Barbara | $1,078.49 | $685.53 |
| Santa Rosa-Petaluma | $1,106.78 | $692.92 |
| Seattle (King Cnty) | $1,154.37 | $740.85 |
| South Carolina | $1,001.42 | $690.02 |
| South Dakota** | $964.54 | $627.52 |
| Southern Maine | $1,000.97 | $666.99 |
| Stockton | $1,042.37 | $673.00 |
| Suburban Chicago | $1,176.44 | $830.32 |
| Tennessee | $951.94 | $645.60 |
| Utah | $1,015.05 | $698.25 |
| Vallejo | $1,151.68 | $707.49 |
| Vermont | $983.41 | $649.76 |
| Virgin Islands | $1,058.26 | $717.54 |
| Virginia | $1,007.71 | $676.43 |
| Visalia | $1,042.37 | $673.00 |
| West Virginia | $1,056.73 | $763.87 |
| Wisconsin | $942.19 | $619.33 |
| Wyoming** | $1,019.86 | $682.85 |
| Yuba City | $1,042.37 | $673.00 |
59426 rates by state
Office rate range in each state. Select a state to see its payment localities.
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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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,261.46 | 1 |
| AL | $940.92 | 1 |
| AR | $926.88 | 1 |
| AZ | $1,022.08 | 1 |
| CA | $1,042.37–$1,239.34 | 29 |
| CO | $1,059.43 | 1 |
| CT | $1,127.73 | 1 |
| DC | $1,175.21 | 1 |
| DE | $1,038.73 | 1 |
| FL | $1,104.95–$1,282.93 | 3 |
| GA | $1,034.15–$1,091.48 | 2 |
| GU | $1,058.22 | 1 |
| HI | $1,058.22 | 1 |
| IA | $935.42 | 1 |
| ID | $948.03 | 1 |
| IL | $1,094.21–$1,238.36 | 4 |
| IN | $952.89 | 1 |
| KS | $945.22 | 1 |
| KY | $994.89 | 1 |
| LA | $999.01–$1,048.08 | 2 |
| MA | $1,058.68–$1,145.52 | 2 |
| MD | $1,054.31–$1,175.21 | 3 |
| ME | $968.43–$1,000.97 | 2 |
| MI | $1,034.78–$1,133.98 | 2 |
| MN | $971.85 | 1 |
| MO | $991.06–$1,034.58 | 3 |
| MS | $958.44 | 1 |
| MT | $1,055.19 | 1 |
| NC | $976.49 | 1 |
| ND | $974.12 | 1 |
| NE | $936.34 | 1 |
| NH | $1,056.43 | 1 |
| NJ | $1,128.42–$1,165.41 | 2 |
| NM | $1,046.40 | 1 |
| NV | $1,033.04 | 1 |
| NY | $992.75–$1,286.73 | 5 |
| OH | $1,018.21 | 1 |
| OK | $977.75 | 1 |
| OR | $1,013.03–$1,076.99 | 2 |
| PA | $1,011.78–$1,108.57 | 2 |
| PR | $1,058.26 | 1 |
| RI | $1,064.30 | 1 |
| SC | $1,001.42 | 1 |
| SD | $964.54 | 1 |
| TN | $951.94 | 1 |
| TX | $1,006.07–$1,107.69 | 8 |
| UT | $1,015.05 | 1 |
| VA | $1,007.71–$1,175.21 | 2 |
| VI | $1,058.26 | 1 |
| VT | $983.41 | 1 |
| WA | $1,052.32–$1,154.37 | 2 |
| WI | $942.19 | 1 |
| WV | $1,056.73 | 1 |
| WY | $1,019.86 | 1 |
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
Swap in your local Medicare rate.
Work 14.30Practice expense 13.20Malpractice 4.10
All indexes start 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
| 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
59426 vs 59425 vs 59400 vs 59409: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 59425Prenatal care
- Choose 59425 for four through six antepartum visits; 59426 is for seven or more.
- 59400Maternity care
- 59400 covers a full maternity package including antepartum care, delivery, and postpartum care. 59426 covers the prenatal portion only.
- 59409Vaginal delivery
- 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
Show the CMS file lines behind this rate
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