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

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

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?

CPT code 59025 refers to a non-stress test (NST) performed during pregnancy. This test monitors fetal heart rate and uterine activity to assess fetal well-being, typically lasting 20–60 minutes. It is commonly ordered for high-risk pregnancies, reduced fetal movement, or post-term pregnancies.

Key Description

Procedure: Electronic fetal heart rate monitoring via cardiotocography.
Purpose: Evaluate fetal oxygenation and placental function.
Documentation Requirements: Start/end times, interpretation, and clinical indication.

When to Use CPT 59025 vs. Other Obstetric Codes

Avoid coding errors by understanding how 59025 differs from related codes:

CPT Code for C-Section (59510, 59514, 59618, etc.):
- Codes for cesarean deliveries are unrelated to 59025. Use 59025 only for NSTs, not delivery procedures.
Prenatal Visit Codes (59425, 59426, etc.):
- Routine prenatal visits are billed separately. NSTs (59025) are additional diagnostic tests.
Global Obstetric Care:
- 59025 is not included in global maternity packages (e.g., CPT 59400). Bill it separately if performed outside routine prenatal care.

Modifiers for CPT 59025 - When Are They Needed?

Modifiers clarify medical billing components. Common modifiers for 59025 include:

Modifier 26 (Professional Component):
Use when the provider only interprets the NST (e.g., in-office interpretation of a test performed elsewhere).
Modifier TC (Technical Component):
Apply if the facility owns the equipment and handles the test administration (rarely used in obstetric settings).
No Modifier:
Bill without modifiers if the provider performs and interprets the test in their office (global service).

CPT 59025 Billing Guidelines

Frequency Limits:
Most payers cover 1–2 NSTs weekly for high-risk pregnancies. Document medical necessity for additional tests.
Revenue Code Association:
When billing hospitals, pair 59025 with revenue code 768 (obstetric services) or 0740 (diagnostic services) on UB-04 forms. Confirm with your facility’s coding manual.
Documentation Tips:
- Specify start/end times.
- Link the test to a diagnosis (e.g., gestational diabetes, IUGR).
- Include interpretation notes in the patient’s chart.
Avoid Denials:
- Do not bill 59025 with routine prenatal visit codes unless the NST is separately performed.

Use diagnosis codes like O36.83 (Maternal care for abnormal fetal heart rate) to justify necessity.

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Final Tips for Accurate Coding

Verify payer rules: Medicaid and private insurers may have unique requirements for modifiers or frequency.
Audit regularly: Ensure documentation aligns with billed services.
Educate staff: Train providers to document start/end times and clinical indications.

By mastering CPT 59025’s guidelines, you’ll reduce claim denials and ensure proper reimbursement for essential prenatal services. Always cross-reference the latest AMA CPT Manuals and payer policies for updates.

Need help optimizing your obstetrics billing? Consult a certified medical coder to avoid costly errors and stay compliant!

FAQ:

Yes, if the NST is performed on the same day as delivery (e.g., prior to induction).

Bill 59025 once per 24-hour period unless the patient is discharged and readmitted.

No. Remote NST monitoring may require alternative codes (e.g., 99091).

Yes, if only one component (professional/technical) is billed. Example: A hospital performs the test (TC), and an external physician interprets it (26).

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