59425 Delivery

CPT 59425

CPT 59425: Antepartum Care Only, 4 to 6 VisitsAntepartum Care Only, 4 to 6 Visits

2027 change This code is scheduled for deletion on January 1, 2027, when CPT unbundles the global maternity package. Current rules apply through 2026 dates of service. See what replaces it →

The short answer

Use 59425 when your practice provided 4 to 6 antepartum visits for a pregnancy but did not perform the delivery, usually because the patient transferred out, moved, or was referred to another practice for delivery. Bill it once, as a single unit, after your care ends. With 7 or more visits the code is 59426; with 1 to 3 visits there is no antepartum code at all, you bill each visit as an E/M service.

Source: CMSSource: ACOGSource: CMS MPFS 2026

When to use 59425

The antepartum-only codes exist for the practice that loses the delivery. When a pregnancy transfers out mid-course, the global package is off the table and payment falls back to visit count. Count every routine antepartum visit the patient had with your practice, then pick the lane: E/M per visit for 1 to 3, 59425 for 4 to 6, 59426 for 7 or more. Most payers want a quantity of one and the last visit date as the date of service, not a line per visit. Problem visits for separate conditions do not count toward the threshold; they were never routine antepartum care and bill as E/M with their own diagnoses either way.

59425 vs 59426 vs per-visit E/M

59425 · 4–6 visits

Routine antepartum visits total 4, 5, or 6
Your practice does not perform the delivery
One unit, billed once after care ends
Last visit date as date of service for most payers

Outside the 4–6 window

7 or more visits: bill 59426 instead
1–3 visits: no antepartum code, bill each as E/M
Full care including delivery: global 59400 or 59510
Never combine an antepartum code with a global code

Documentation checklist

The whole claim rests on the visit count and the reason your practice did not deliver, so both need to be unambiguous in the record.

✓ Antepartum flow sheet listing every routine visit with dates

✓ Visit count stated plainly: the payer should not have to reconstruct it

✓ Transfer, referral, or relocation documented with the date care ended

✓ Receiving practice identified where known

✓ Problem visits carved out with their own E/M claims and diagnoses

✓ Quantity of one on the claim line, not one line per visit

Global package rules

59425 is the antepartum slice of the global package, used when the package breaks. The rule that matters: one pregnancy supports one global code at most, and never a global code plus an antepartum code from the same practice. If your practice ends up performing the delivery after all, the antepartum code disappears into the global fee, or pairs with a delivery-only code like 59409 or 59410 when the payer's policy calls for component billing. See The Global OB Package, explained. ACOG

Reimbursement

2026 · national Medicare averages

Component	Work RVU	Total RVU	2026 rate
59425Antepartum care	7.80	17.21	$574.83

National amounts under the 2026 Medicare Physician Fee Schedule (non-facility total RVU x $33.4009 conversion factor, no locality/MAC adjustment). Commercial and Medicaid rates differ. Verify current values with your MAC before billing.

Common denials

CO-236 Billed alongside a global code

Why it happens

The claim combined 59425 with 59400 or another global code for the same pregnancy, which payers treat as unbundling.

How to fix

Bill one structure. If your practice delivered, the antepartum visits belong inside the global fee, not on a separate line.

Source: NCCI

CO-50 Visit count outside the 4–6 range

Why it happens

Records showed 7 or more visits, or fewer than 4, so the code did not match the documented count.

How to fix

Rebill 59426 for 7 or more visits, or individual E/M codes for 1 to 3. Attach the flow sheet on appeal.

Source: ACOG

CO-119 Global fee already paid for the pregnancy

Why it happens

The receiving practice billed a full global package that overlapped your antepartum span.

How to fix

Coordinate the split: the delivering practice bills delivery and postpartum components, you bill 59425 for your documented visits, with the transfer date in both records.

Source: CMS

CO-151 Units exceeded one

Why it happens

The claim listed a unit per visit, and the payer paid one and denied the rest, or denied the line outright.

How to fix

Resubmit with a quantity of one. The code represents the whole 4–6 visit bundle, not a per-visit fee.

Source: CMS

CO-16 Date of service span problems

Why it happens

The claim used a date range or the first visit date where the payer wanted the last visit date.

How to fix

Check the payer's convention; most want the final antepartum visit as the date of service. Resubmit accordingly.

Source: CMS

FAQ

What is the CPT code description for 59425?

In plain language, 59425 covers 4 to 6 routine antepartum visits provided by a practice that does not go on to perform the delivery, billed once as a bundle rather than visit by visit.

What counts as a visit toward the 4 to 6 threshold?

Routine antepartum visits: the scheduled checks with weight, blood pressure, fundal height, and fetal heart tones. Problem visits for separate conditions bill as E/M with their own diagnoses and do not count.

What if I saw the patient only twice before she transferred?

There is no antepartum package code for 1 to 3 visits. Bill each visit as an evaluation and management service with the appropriate level.

When do I submit the claim, and with what date of service?

After your antepartum care ends, typically at transfer. Most payers want the last visit date as the date of service and a quantity of one; a few want the date span, so check the payer's convention.

Can I bill 59425 if my practice ends up delivering the baby?

Not alongside a global code. If you delivered and provided the full span, bill the global package. If you delivered after a late transfer in, pair the antepartum code for your visit count with a delivery code like 59409 or 59410.

Do ultrasounds and labs count toward the visit total?

No. Imaging, non-stress tests, and lab work are separately billable services outside the antepartum bundle and do not affect the visit count.

CPT® is a registered trademark of the American Medical Association. Educational reference only, not billing, legal, or medical advice. Maintained by Ouma Health, a maternal-fetal telemedicine practice. Printed from obcodingguide.com, content current as of July 2026.