$1,006.07–$1,107.69
Both report antepartum care only; choose 59425 for four to six visits and 59426 for seven or more.
On this page
CMS RVU26D · Effective 2026-10-01
59425 Prenatal care Medicare reimbursement rates in Texas
Reports a course of four to six prenatal care visits when the clinician provides antepartum care but does not bill the complete obstetrical package. Compare 59425 office and facility rates across CMS payment localities in Texas.
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 59425 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$547.96–$603.24
8 of 8 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 59425 pays more and less in Texas
8 payment localities
$547.96 to $603.24
Maternity care
About 59425: Antepartum care, four to six visits
Reports a course of four to six prenatal care visits when the clinician provides antepartum care but does not bill the complete obstetrical package.
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.
CMS billing rules for 59425
- Global period
- Maternity code: the usual global surgery rules do not apply.
Where the value comes from
- Work RVU7.80 · 45%
- Practice expense (office) RVU7.18 · 42%
- Malpractice RVU2.23 · 13%
368
Medicare services in 2024 · #3803 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.
59425 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
59425 is limited to antepartum care. 59400 covers antepartum care, vaginal delivery, and postpartum care as an obstetrical package.
No office rate
59409 reports vaginal delivery only. It does not represent a course of prenatal visits.
No office rate
59410 reports vaginal delivery with postpartum care; 59425 reports prenatal care only.
Compare 59425 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $580.77 | Facility $387.12 |
| Beaumont | Office $547.96 | Facility $381.39 |
| Brazoria | Office $558.37 | Facility $376.98 |
| Dallas | Office $565.64 | Facility $383.33 |
| Fort Worth | Office $564.21 | Facility $383.73 |
| Galveston | Office $562.42 | Facility $380.67 |
| Houston | Office $603.24 | Facility $421.49 |
| Rest Of Texas | Office $555.37 | Facility $381.67 |
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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 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.
6,65759410,,Obstetrical care,A,,18.76,5.13,NA,5.13,,5.34,29.23,29.23,0,MMM,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,65859412,,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