Comprehensive Guide to CPT Code 59025 Billing, Modifiers, and Key Guidelines

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Accurate medical coding is critical for proper reimbursement and compliance, especially in obstetrics. CPT code 59025 is frequently used in prenatal care, but confusion about its application can lead to billing errors. 

This guide clarifies how to use CPT 59025 effectively, including its description, modifiers, billing guidelines, and how it differs from other obstetric codes.

What is CPT Code 59025?

The CPT Code 59025 refers to a fetal non-stress test (NST) performed during pregnancy. This diagnostic test monitors the fetal heart rate in relation to uterine activity, helping physicians evaluate fetal well-being and placental function.

  • Procedure: Electronic fetal monitoring via cardiotocography.
  • Purpose: Identify risks such as fetal distress, hypoxia, or placental insufficiency.
  • Duration: Typically lasts 20–60 minutes.
  • Common Uses: High-risk pregnancies, reduced fetal movement, gestational diabetes, hypertension, or post-term monitoring.

In 2025, CPT 59025 remains a critical code for ensuring proper reimbursement in obstetric billing.

CPT 59025 Description

The 59025 CPT description defines this as a non-stress test (NST) performed on a pregnant patient to monitor fetal well-being. It is not included in global maternity care packages and must be billed separately.

When to Use CPT 59025 vs. Other Pregnancy Codes

To avoid denials, it’s essential to know when CPT 59025 applies versus related obstetric codes:

  • Prenatal Visit Codes (59425, 59426): Bill separately; NSTs are not bundled.
  • C-Section Codes (59510, 59514, 59618): Delivery codes; do not overlap with 59025.
  • Global Obstetric Care (59400): Does not include NST testing.
  • Fetal Ultrasound Codes (76815, 76816): Use only if imaging is performed; NST is different.

Does CPT Code 59025 Need a Modifier?

Yes, modifiers may apply depending on how the NST is performed:

  • Modifier 26 (Professional Component): Used when only the interpretation is performed.
  • Modifier TC (Technical Component): Used when only test administration is provided (rare).
  • No Modifier: Use when the provider both performs and interprets the NST (global service).

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CPT 59025 Billing Guidelines (2025)

Accurate billing for CPT 59025 requires following payer-specific rules:

    • Frequency: Typically covered 1–2 times per week for high-risk pregnancies.
    • Documentation: Must include start/end times, reason for testing, and physician interpretation.
    • Diagnosis Codes: Pair with ICD-10 codes such as:
      • O36.83 – Maternal care for abnormal fetal heart rate
      • O09.9 – Supervision of high-risk pregnancy
      • O48.0 – Post-term pregnancy
    • Hospital Billing: Link with revenue code 768 (obstetric services) or 0740 (diagnostic services) on UB-04 forms.
    • Avoid Denials: Never bill 59025 with routine prenatal visits unless documented separately.

Reimbursement for CPT 59025

Reimbursement varies by payer but averages:

  • $40–$90 per test (professional + technical components).
  • Higher rates may apply in hospital settings.

Always check payer policies and Medicaid/Medicare guidelines for updated fee schedules.

Related and Similar CPT Codes

  • 76815, 76816: Fetal ultrasound for limited or follow-up.
  • 59425, 59426: Routine prenatal visits (does not include NST).
  • 59510, 59618: Cesarean deliveries.

Conclusion

The CPT Code 59025 plays a vital role in obstetric billing, ensuring accurate reimbursement for fetal non-stress tests. By following 2025 billing guidelines, documenting medical necessity, and applying correct modifiers, providers can reduce denials and support high-quality prenatal care.

Cures Medical Billing specializes in OB/GYN coding compliance and helps practices avoid costly errors. If your team struggles with 59025 billing denials, our experts provide free billing audits to optimize your revenue cycle.

Frequently Asked Questions (FAQs)

It’s used to bill fetal non-stress tests (NSTs) performed during pregnancy.

Yes. Most payers, including Medicare and Medicaid, cover 59025 when medically necessary.

Yes, if only the professional (26) or technical (TC) component is billed. Otherwise, bill globally.

Typically 1–2 times per week, unless additional testing is justified with documentation.

The CPT code for an NST during pregnancy is 59025.

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