$601.74–$698.55
Choose 59425 for four through six antepartum visits; 59426 is for seven or more.
On this page
CMS RVU26D · Effective 2026-10-01
59426 Prenatal care Medicare reimbursement rates in Florida
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. Compare 59426 office and facility rates across CMS payment localities in Florida.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 59426 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$1104.95–$1282.93
3 of 3 localities have a supported rate.
Facility setting
$782.77–$932.10
3 of 3 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 59426 pays more and less in Florida
3 payment localities
$1104.95 to $1282.93
Obstetrics
About 59426: Antepartum care, seven or more visits
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.
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.
CMS billing rules for 59426
- Global period
- Maternity code: the usual global surgery rules do not apply.
Where the value comes from
- Work RVU14.30 · 45%
- Practice expense (office) RVU13.20 · 42%
- Malpractice RVU4.10 · 13%
395
Medicare services in 2024 · #3748 by national volume
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.
59426 compared with similar codes
Office rates for Florida, from the same CMS release.
No office rate
59400 covers a full maternity package including antepartum care, delivery, and postpartum care. 59426 covers the prenatal portion only.
No office rate
59409 represents vaginal delivery care. Use 59426 for qualifying antepartum care, not for the delivery service.
Compare 59426 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
$1171.85
Facility
$830.45
Miami →
Office / nonfacility
$1282.93
Facility
$932.10
Rest Of Florida →
Office / nonfacility
$1104.95
Facility
$782.77
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,65859412,,Antepartum manipulation,A,,1.71,0.57,NA,0.57,,0.54,2.82,2.82,0,MMM,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,65959414,,Deliver placenta,A,,1.61,0.35,NA,0.35,,0.50,2.46,2.46,0,MMM,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,66059425,,Antepartum care only,A,,7.80,7.18,,1.70,,2.23,17.21,11.73,0,MMM,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,66159426,,Antepartum care only,A,,14.30,13.20,,3.11,,4.10,31.60,21.51,0,MMM,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,66259430,,Care after delivery,A,,3.22,3.68,,0.70,,0.92,7.82,4.84,0,MMM,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,66359510,,Cesarean delivery,A,,41.05,20.00,NA,20.00,,13.00,74.05,74.05,0,MMM,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,66459514,,Cesarean delivery only,A,,16.13,3.52,NA,3.52,,5.01,24.66,24.66,0,MMM,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00