CPT 59425
Global MMM ActiveAntepartum care only
CPT 59425 Billing & Documentation Guide
CPT code 59425 (Antepartum care only) is classified under Surgery (Urinary/Reproductive) with a global period indicator of MMM. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.8, a non-facility practice expense RVU of 7.18, and a malpractice RVU of 2.23, a total non-facility RVU of 17.21 and facility RVU of 11.73. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $579.89, though rates vary from $504.89 to $700.66 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 59425, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 59425 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Maternity codes (separate billing rules)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 59425 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 59425
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.8 | 7.8 |
| Practice Expense RVU | 7.18 | 1.7 |
| Malpractice RVU | 2.23 | 2.23 |
| Total RVU | 17.21 | 11.73 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 59425
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $594.03 | $377.44 | $567.72 - $674.93 | 29 |
| Florida | $646.14 | $462.49 | $601.74 - $698.55 | 3 |
| Georgia | $578.83 | $404.21 | $563.23 - $594.42 | 2 |
| Illinois | $635.5 | $458.65 | $595.9 - $674.31 | 4 |
| Michigan | $590.55 | $418.68 | $563.57 - $617.53 | 2 |
| North Carolina | $531.87 | $361.1 | $531.87 - $531.87 | 1 |
| New York | $641.69 | $437.49 | $540.72 - $700.66 | 5 |
| Ohio | $554.56 | $387.45 | $554.56 - $554.56 | 1 |
| Pennsylvania | $577.4 | $398.12 | $551.07 - $603.73 | 2 |
| Texas | $567.25 | $387.05 | $547.96 - $603.24 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 59425
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 59425 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 37202 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 59426 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
Frequently Asked Questions, CPT 59425
What does CPT code 59425 mean? +
CPT code 59425 represents: Antepartum care only. It's in the Surgery (Urinary/Reproductive) category with a global period of MMM.
What is the Medicare reimbursement for CPT 59425? +
The 2026 Medicare national average non-facility payment for CPT 59425 is $579.89. Rates range from $504.89 to $700.66 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 59425? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 59425? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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