October 9, 2025
Accurate billing is essential in obstetrics, especially when patients transition between providers or insurance plans. CPT Code 59425 is designed for antepartum care with 4 to 6 prenatal visits when delivery and postpartum services are not included.
This guide explains what CPT 59425 means, when to use it, related codes, reimbursement challenges, and real-world billing tips so your practice can stay compliant and maximize reimbursement.
According to the AMA CPT guidelines, CPT Code 59425 is defined as:
“Antepartum care only; 4 to 6 visits.”
This code is billed when a provider manages four to six prenatal visits but does not provide delivery or postpartum care.
You should use CPT 59425 in these common scenarios:
Key takeaway: CPT 59425 ensures providers are reimbursed fairly for prenatal care, even when care is transferred.
To bill correctly, it’s important to understand related OB codes:
Correct billing and documentation are crucial to avoid denials. Keep these rules in mind:
Despite being straightforward, CPT 59425 billing comes with challenges:
Pro Tip: Always verify payer-specific maternity guidelines to prevent claim rejections.
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To secure accurate payments:
Providers often confuse CPT 59425 (antepartum visits) with CPT 59025 (fetal non-stress test). Here’s the distinction:
Does CPT 59025 need a modifier?
Usually no, but payer rules may require modifier -26 (professional component) or modifier -TC (technical component). Always check with your MAC or commercial payer.
Correctly billing CPT Code 59425 ensures providers are fairly reimbursed for partial antepartum care. By understanding related codes, payer rules, and documentation requirements, your practice can avoid denials and secure maximum reimbursement.
Cures Medical Billing specializes in OB/GYN coding, CPT 59425 billing, and fetal monitoring claims (CPT 59025). Our team ensures compliance, reduces denials, and improves cash flow for your practice.
Contact us today for a free consultation and let our experts streamline your obstetrics billing.
CPT 59425 is used for antepartum care of 4–6 prenatal visits only, without delivery or postpartum services.
59425 covers 4–6 visits, while 59426 covers 7 or more visits.
CPT 59025 is the code for a fetal non-stress test (NST), usually done in the third trimester to check fetal well-being.
Not always. However, if billing separately for professional vs. facility services, use modifiers -26 or -TC.
Yes, but documentation must support both the antepartum visit and the fetal monitoring test.
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