Billing code 59425: Prenatal careMedicare rate & RVUs in Ohio
Reports a course of four to six prenatal care visits when the clinician provides antepartum care but does not bill the complete obstetrical package.
Medicare pays $554.56 for 59425 in the office in Ohio (Ohio). 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.
On this page 9 sections
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.
59425 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $554.56 | $387.45 |
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
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.
Payment rules and modifiers for 59425
The CMS indicators that decide how 59425 is paid alongside other services.
CMS payment indicators · 59425
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. |
59425 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 59426Prenatal care
- Both report antepartum care only; choose 59425 for four to six visits and 59426 for seven or more.
- 59400Maternity care
- 59425 is limited to antepartum care. 59400 covers antepartum care, vaginal delivery, and postpartum care as an obstetrical package.
- 59409Vaginal delivery
- 59409 reports vaginal delivery only. It does not represent a course of prenatal visits.
- 59410Vaginal delivery
- 59410 reports vaginal delivery with postpartum care; 59425 reports prenatal care only.
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
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