Summary & Overview
CPT 59425: Antepartum Care Only, 4-6 Prenatal Visits
CPT code 59425 represents antepartum care only, specifically for 4 to 6 prenatal visits provided to pregnant patients. This code is a critical component in obstetric billing, allowing providers to accurately report and receive reimbursement for partial prenatal care when the full global maternity package is not completed. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage across commercial and government insurance plans.
The publication offers a comprehensive overview of 59425, detailing its clinical context within maternity care, typical site of service, and its role in the spectrum of obstetric billing. Readers will gain insight into payer coverage, relevant policy updates, and benchmarks for utilization. The summary also highlights associated modifiers and related CPT codes, providing clarity on how 59425 fits within the broader landscape of obstetric services. This information is valuable for understanding national trends in prenatal care billing and the nuances of reporting partial antepartum services.
CPT Code Overview
CPT code 59425 is used to report antepartum care only for patients receiving obstetric (maternity) care involving 4 to 6 visits. This code is typically billed when a patient receives prenatal care in an office setting, but does not complete the full global obstetric package. The service is most commonly provided in the office (Place of Service 11), where obstetricians and gynecologists monitor the health and progress of pregnancy during the specified number of visits. This code is essential for accurately capturing and reimbursing partial prenatal care when fewer than seven visits are provided.
Clinical & Coding Specifications
Clinical Context
A patient presents to an obstetrics office for routine prenatal care. Over the course of her pregnancy, she receives between four and six antepartum visits, which include assessment of maternal and fetal health, counseling, and management of any pregnancy-related conditions. The visits may address normal pregnancy supervision or high-risk factors such as pre-existing hypertension. The care is provided by an obstetrician or gynecologist in an office setting, and does not include delivery or postpartum care. The service is billed using CPT code 59425 for antepartum care only, covering 4-6 visits.
Coding Specifications
| Modifier Code | Description | When Used |
|---|---|---|
52 | Reduced Services | Used when fewer than the typical number of antepartum visits (4-6) are provided, indicating partial completion of the service. |
59 | Distinct Procedural Service | Used when antepartum care is provided as a distinct service from other procedures, such as when multiple services are performed on the same day. |