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CPT 59425: Mini-Global Obstetric Care — Limited Antepartum Visits
CPT code 59425 denotes a mini-global obstetric service for providers who furnish only four to six antepartum visits or who perform delivery after partial antepartum care by another provider. Nationally, this code matters because it addresses common care transitions in prenatal management — including patient transfers between practices and pregnancy terminations prior to delivery — and influences billing when payers restrict global obstetric codes. Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical and billing context for 59425, how it differs from full global obstetric codes (such as 59400), and which clinical scenarios typically trigger its use. The publication outlines the service type (limited antepartum visits and delivery-related care), typical sites of service (office/outpatient for antepartum visits and hospital for delivery), and associated diagnoses commonly used with this code. It also compares 59425 to related CPT codes for antepartum-only services and global obstetric care, highlighting when each code is appropriate. The summary provides practical benchmarking and policy-relevant considerations for national payer practices and billing consistency. Data not available in the input for specific utilization rates or payer-specific reimbursement amounts.
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Billing Code Overview
CPT code 59425 describes a mini-global obstetric service used when a provider delivers a limited number of antepartum visits (four to six) for a pregnancy. This scenario typically occurs when a patient transfers out of the practice before delivery or the pregnancy terminates prior to delivery. The code also applies when a provider who did not provide the full course of antepartum care performs the delivery (with or without postpartum care) because the patient transferred into the practice and the payer does not allow a global services code such as 59400.
Service Type: Obstetric care — limited antepartum visits / delivery-related service
Typical Site of Service: Office or outpatient obstetrics clinic and hospital delivery setting, depending on whether the provider performs antepartum visits only or also performs the delivery.
National Reimbursement Benchmarks
Medicare’s national mean of $582.80 sits below BUCA’s average commercial mean of $618.20 for CPT 59425, indicating BUCA pays modestly higher on average than Medicare by $35.40. Blue Cross Blue Shield and Aetna have means of $572.70 and $513.50 respectively, while Cigna and UnitedHealth Group show substantially higher means at $743.10 and $734.20, reflecting a wide spread in commercial payer averages around the Medicare baseline.
Dispersion measured as the interquartile distance (P75 minus P25) highlights variability across payers: Cigna’s IQR is $482.20 (from $478.30 to $906.50) and UnitedHealth Group’s IQR is $462.90 (from $463.40 to $926.30), representing the widest ranges among listed payers. Aetna’s IQR is $281.20 and Blue Cross Blue Shield’s is $153.10, making BCBS the tightest of those with full quartile data; BUCA’s IQR is $345.60 and Medicare’s IQR is $50.00, indicating Medicare payments are relatively concentrated around its central tendency.