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See a sample rate comparisonCPT 59425 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Antepartum Care Only ; 4-6 Visits
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures for Maternity Care and Delivery |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None U2 U3 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 59425 |
| Medicaid Fee Schedule | View Medicaid rates for 59425 |
National average reimbursement for CPT 59425 by major payers:
$656.76
$607.67
$681.04
$642.99
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CPT 59425
5 of 25 sample ratesHigher to lower in this preview
David Mateo
$2,048.22Published rateAnxhela Treska
$1,137.06Published rateSmh Physician Services Inc
$814.69Published rateChristopher Sullivan
Carilion Healthcare Corporation
$675.23Published ratePedro Alvarez
Suncoast Community Health Centers Inc
$269.22Published rate
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See a sample payer proposalCPT 59425 vs. Other Surgical Procedures for Maternity Care and Delivery Codes
The CPT 59425 code is part of the Surgery services used for Surgical Procedures for Maternity Care and Delivery. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 59425 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 59400-CPT | High | Routine Obstetric Care Includi, Routine Obstetric Care Including Antepartum Care Vaginaldelivery (With Or Without Episiotomy Andor Forceps) And Postpartum Care |
| 59409-CPT | High | Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps) |
| 59410-CPT | High | Vagnal Dlvery Only (W//W/O Episiotomy &/Or Forcps); Inc, Vaginal Delivery Only (With Or Without Episiotomy And/Or Forceps); Inc |
| 59425-CPT | Moderate | Antepartum Care Only ; 4-6 Visits |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 59425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 59425 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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