What CPT 59425 Is and Why It Exists

How 59425 Fits Into the OB Coding Family (Quick Map)

Use this quick mapping to orient your coding:

How Many Visits Count Toward 59425—and Why Precision Matters

59425 requires exactly 4–6 visits. That count should reflect billable antepartum visits that meet clinical and payer criteria (see next section). Counting wrong is the #1 denial driver for this code.

Key rules of thumb:

Count visits where the provider (or incident-to staff under payer rules) performs a prenatal evaluation with documentation (history, exam as indicated, fetal assessment, counseling).

Do not count lab-only trips, imaging-only visits, nurse-only blood pressure checks, injection-only visits, or administrative encounters, unless payer policy explicitly allows them to qualify as prenatal visits for the antepartum package.

Telehealth: Count only if the payer accepts telehealth as a qualifying prenatal visit in the antepartum package and the visit meets medical-necessity and documentation standards. 

How to Decide If a Visit Counts (Clinical/Operational Quick Test)

 How to Document 59425: The Gold-Standard Checklist

Each counted prenatal visit should include enough detail to demonstrate it truly was prenatal care. Use this documentation checklist:

How to Bill 59425 on the Claim (Professional Claim Focus)

Professional (CMS-1500) essentials for the 59425 line:

CPT: 59425

Units: 1

Date(s): Follow payer guidance. Many accept a from–to span covering the earliest and latest qualifying visit; others require the last visit date. Check policy and be consistent.

Diagnosis: Pregnancy supervision codes (e.g., Z34. for routine pregnancy; O09. for high-risk) per clinical status; add problem codes as appropriate.

Place of Service (POS): Usually office or telehealth POS as applicable.

Rendering & Billing Providers: Ensure correct NPI/Taxonomy; if split providers within the same group, coordinate (see transfer-of-care section).

Optional claim tips:

Include itemized visit list in claim notes (loop 2300 NTE for EDI) if denials are recurring.

If payer requests medical records, provide a visit log plus all corresponding notes.

How 59425 Interacts With Global OB Packages—and Why You Must Coordinate

If another provider bills a global package (e.g., 59400), your 59425 can be challenged unless the transfer of care is clear and non-overlapping. Coordinate early to determine who will:

Bill partial antepartum (59425/59426),

Bill delivery only (59409/59514/etc.), and/or

Bill postpartum only (59430).

How to Handle Transfers of Care (Inbound/Outbound) Without Losing Revenue

Outbound (you start care, patient later transfers):

Track visit count in real time.

When the 4th, 5th, or 6th qualifying visit occurs—and you know you won’t deliver—hold and bill 59425 at the appropriate time.

Provide a transfer summary to the receiving provider (GA, labs, issues).

Inbound (patient transfers to you):

Ask prior provider for visit count & dates (they may bill 59425/59426).

Keep your own count from day one.

Decide if you’ll bill global (if you deliver and do postpartum) or partial (if you only add 4–6 or 7+ visits without delivery).

Transfer responsibilities matrix:

How to Count Telehealth Prenatal Visits—and Why Policies Differ

Telehealth may count if:

The payer explicitly allows telehealth as a qualifying prenatal visit within the antepartum “package,”

The modality (video vs audio-only) meets policy,

Documentation is complete (location, consent if required, vitals when appropriate, counseling, exam elements feasible via telehealth, etc.).

How 59425 Differs From 59426—and Why Mis-Coding Hurts

How to Separate “Included” vs “Separately Billable” Services—and Why Clarity Saves Time

While 59425 packages antepartum visits, many ancillary services are separately billable. Always check payer edits.

How to Prevent Denials: Common Pitfalls and Fixes

How to Build a Bulletproof Prenatal Visit Log (Template)

Use a centralized visit log to support your claim:

How to Code When Fewer Than Four Visits Happen (And Why E/M Is Your Friend)

If the patient leaves after 1–3 visits, do not use 59425. Instead:

Bill E/M per visit (9920x/9921x or any payer-specific prenatal E/M convention).

Use appropriate pregnancy diagnoses and problem codes.

If another provider later bills global or partial, your E/M stands on its own.

59425 requires the threshold. Anything less belongs in E/M land.

Why 59425 Is Critical for Midwives, FQHCs, and Multi-Provider Teams

Midwives and family physicians often provide substantial prenatal care but refer out for high-risk delivery. FQHCs/RHCs may have separate reimbursement constructs but still must document visit counts and services. 59425:

Recognizes real prenatal work without delivery,

Encourages collaboration across care settings,

Helps practices maintain revenue integrity during transfers. 

How to Align Front Desk, Nursing, and Billing (Operational Playbook)

Intake flag: Mark “Transfer of Care Likely” if patient mentions moving, switching insurance, or making a delivery plan elsewhere.

Visit-count tracker: Start the prenatal visit log immediately.

Coding checkpoint: At the 4th visit, alert billing to evaluate timing of 59425.

Hold/Release logic: If more visits are expected but no delivery will occur with you, consider holding until the 6th visit—unless payer timing dictates otherwise.

Claim assembly: Confirm date span vs single date, diagnosis, and no overlap with another provider’s package.

Denial feedback loop: Maintain a denial reason dashboard; tune workflows quarterly.

          A crisp workflow turns chaotic handoffs into clean claims.

How to Build an Internal Policy for Telehealth Prenatal Care

Define which payers count telehealth toward antepartum packages.

Specify modality rules (video vs audio-only).

Standardize documentation (modality, consent, vitals feasible, fetal status discussion, safety counseling).

Train staff to schedule telehealth vs in-person appropriately (e.g., certain gestational milestones in person).

Why Payers Audit 59425—and How to Pass With Confidence

Why they audit: It’s a “threshold” code; easy to misuse.
How to pass:

Produce the visit log immediately.

Provide complete notes for each counted visit.

Show transfer documentation (who delivered, who did postpartum).

Demonstrate no overlap with global billing.

If telehealth is included, attach written payer policy excerpt in appeals.

 How to Craft Rock-Solid Appeal Language (If Denied)

Appeal anchor points:

You provided 4–6 qualifying prenatal visits (attach log + notes).

The patient did not receive delivery/postpartum with your group.

Submitted code accurately reflects CPT guidance for partial antepartum care.

Any ancillary services were billed separately per policy (or included if required).

Dates on the claim reflect payer’s required format (span or last visit).

If telehealth was counted, cite the payer’s written telehealth policy.

How to Price, Contract, and Post Charges—Without Getting Stuck

Charge master: Include 59425 and 59426 with rational fee differentials (reflecting intensity/volume).

Contract language: Clarify partial antepartum billing in payer contracts to reduce post-payment disputes.

Posting discipline: If a span is required, ensure your PM/EDI system can transmit from–to dates cleanly; otherwise use last visit date per payer rule.

How to Train Teams (Short Curriculum Outline)

Coders/Billers: Threshold logic, payer nuances (span vs single date), ancillary carve-outs.

Front Desk: Intake flags, scheduling milestones, telehealth rules.

Clinicians: Documentation checklist, transfer summaries, patient education content.

Revenue Integrity/Audit: Random chart audits each quarter; verify visit counts vs claims.

How to Use 59425 in High-Risk Pregnancies—and Why Diagnosis Matters

For high-risk pregnancies (e.g., O09. supervision codes; co-morbidities coded from O chapters), 59425 still applies if you render 4–6 antepartum visits without delivery/postpartum. Ancillary studies (NSTs, growth scans) remain separately billable if medically necessary.

How to Time the Claim: When to Bill 59425 and Why Timing Affects Clean-Claims Rate

Best practice: Bill after the 4th–6th qualifying visit and when it’s clear you will not deliver.

If patient might return: Consider holding until you’re confident about total visit count and delivery plan (balance AR timeliness with accuracy).

End of pregnancy/year moves: If the patient moves late, don’t wait indefinitely—submit with the 4–6 visits you provided, include a note if delivery provider is unknown yet. 

How to Build a One-Page SOP (Standard Operating Procedure) Your Auditor Will Love

SOP sections to include:

Scope: Partial antepartum coding using 59425/59426.

Definitions: What counts as a prenatal visit; telehealth rules per payer.

Workflow: Intake flags, visit logging, coding checkpoint at visit #4.

Documentation: Required elements per visit; transfer summary template.

Claim Rules: Date span vs single date, diagnosis conventions.

Quality Controls: Monthly count vs claim reconciliation; denial dashboard; corrective action.

How to Present 59425 Data in Your RCM Dashboard—and Why Visuals Drive Behavior

Track:

# of 59425 claims per month

Average days to bill after threshold met

Denial rate and top denial reasons (visit count, overlap, policy)

Appeal success rate

Net collection rate for 59425 vs 59426 vs global

Why 59425 Protects Continuity of Care and Patient Access

Patients deserve smooth transitions. 59425:

Compensates providers who start care but can’t finish it,

Keeps doors open for late transfers, and

Encourages collaboration without financial penalty.

How to Communicate With Patients About Transfers (Plain-Language Script)

Explain that prenatal care is sometimes split across teams, and billing codes reflect that.

Reassure that transfer summaries ensure the next provider has everything they need.

Clarify insurance questions early, especially if networks or benefits change mid-pregnancy.

How to Build a Reusable Prenatal Note Template (Snippet You Can Adapt)

Subjective: Weeks GA, concerns/symptoms, fetal movement, ROS as pertinent.
Objective: Vitals, fundal height, fetal heart tones, edema, weight/BMI, targeted exam.
Assessment: Normal pregnancy supervision (Z34.) or high-risk (O09.) + any complications (O-codes).
Plan: Orders (labs/US/NST), counseling topics (nutrition, warning signs, L&D planning), follow-up timing.
Telehealth fields (if used): Modality, location, consent, vitals feasibility, safety counseling.

How to Prevent Overlap With Delivery/Postpartum Claims—and Why Transfer Summaries Are Evidence

Transfer summary essentials:

Patient identifiers, EDD, GA at transfer,

Visit dates and key findings,

Completed labs/imaging,

Risk factors/active problems,

Outstanding orders,

Contact information.

How to Final-Check a 59425 Claim Before Submission (10-Point Pre-Flight)

Visit count = 4–6

All visits qualify (see table)

Documentation complete per checklist

Transfer scenario resolved (if applicable)

Diagnosis codes match clinical course

Span vs single date per payer rule

No overlap with global claims (to your knowledge)

Ancillaries billed separately where allowed

Telehealth counted only with written policy

Internal log attached in notes if payer is denial-prone

 Why Internal Audits of 59425 Pay Off (And How to Do Them Lightly)

Sample 10–20% of 59425 claims monthly.

Verify visit counts, documentation, and non-overlap.

Score findings; feedback to clinicians/coders within 2 weeks.

Trend denial categories and update SOP/training quarterly.

How to Explain 59425 to New Team Members in 60 Seconds (Manager Script)

“59425 is antepartum care only for 4–6 prenatal visits. It’s for cases where we don’t deliver or do postpartum. We must count only qualifying prenatal visits (not labs/US alone). If we hit 7+, we use 59426. For <4, bill E/M per visit. Follow the documentation checklist, log every visit, and watch for telehealth rules and transfer overlaps.”

How to Handle Edge Cases (And Why Conservative Coding Wins)

Uncertain delivery provider: If likely elsewhere, bill 59425 once you’re at 4–6 and document that delivery will not be with you.

Intermittent prenatal care with long gaps: As long as the visits are prenatal and within the same pregnancy episode, they can count; document context.

High-risk consults only: If you’re not providing ongoing prenatal care but consultative E/M, those are typically E/M—don’t force 59425.

How to Build a One-Page Staff Handout (Included vs Separate Services)

Why: Quick references reduce guesswork at the point of care.

How to Write a Cleaner Claim Comment (If Your Payer Likes Notes)

“Antepartum care only: 6 prenatal visits rendered on [list dates]. Patient transferred for delivery/postpartum to [provider/facility, if known]. Telehealth counted? No/Yes (video) per [payer] policy.”

Why 59425 Belongs in Your Anesthesia/CRNA-Affiliated Clinics’ Playbook Too

If your organization spans obstetrics and anesthesia coverage, you’ll likely see patient transfers between clinics or facilities. Ensuring OB teams use 59425/59426 properly:

Minimizes global-overlap conflicts with facility-based billing,

Keeps your compliance posture strong across service lines, and

Protects revenue that funds staffing and call coverage. 

 Final Take: Why Mastering 59425 Is a Strategic Advantage

Getting CPT 59425 right is more than just avoiding denials. It:

Protects access for patients who transfer,

Rewards real work done by your clinicians,

Reduces friction with downstream delivery providers, and

Demonstrates discipline to payers and auditors.

What exactly does CPT 59425 cover, and when should it be used?

CPT 59425 is the CPT code for antepartum care only, 4–6 visits. It is used when a provider or group delivers exactly four, five, or six qualifying prenatal visits but does not provide delivery or postpartum care. It bridges the gap between billing individual E/M visits (<4) and a full global package (59400/59510, etc.). It’s ideal for patients who transfer care, for providers offering limited prenatal care (such as midwives or family doctors who don’t perform deliveries), or for practices covering only part of the pregnancy.

How do I determine whether a prenatal visit qualifies toward the 4–6 visit threshold?

A qualifying visit must include a face-to-face or approved telehealth evaluation that addresses the pregnancy, with documentation of maternal/fetal assessment, history, and plan. Visits that only involve labs, imaging, or nurse-only vitals do not count unless the payer policy explicitly says otherwise. Telehealth visits may count if they meet payer rules and include adequate documentation (e.g., gestational age, patient counseling, fetal status as feasible).

What’s the difference between CPT 59425 and CPT 59426?

If you document seven or more visits, you must use 59426, not 59425. Using the wrong code can trigger denials or underpayment.

When is it better to bill per-visit E/M codes instead of 59425?

Use per-visit E/M codes (e.g., 99212–99215) when you provide fewer than four prenatal visits, or when the visits are not part of a comprehensive antepartum plan (e.g., one-time consults, problem-focused OB visits outside routine supervision). Billing 59425 for fewer than four visits is non-compliant and usually denied.

How do I handle a transfer of care when a patient moves mid-pregnancy?

If you are the sending provider and have completed 4–6 visits, bill CPT 59425 once you know you won’t deliver or provide postpartum care. Send a clear transfer summary (dates, gestational age, labs, risk factors) to the new provider.

If you are the receiving provider, verify how many visits the patient already had, count your own visits, and decide whether you’ll bill globally (if delivering) or as partial care (59425/59426). Clear communication prevents double-billing or missed reimbursement.

What documentation elements should be included in each counted prenatal visit?

A: Each visit should have:

Date of service and gestational age

Vital signs and pregnancy-specific assessments (fundal height, fetal heart tones, weight)

Maternal history and current concerns

Fetal status and growth (as appropriate)

Counseling (nutrition, warning signs, delivery planning)

Orders and follow-up plan

Signature and credentials

Can I include telehealth prenatal visits in the count for CPT 59425?

Yes, if the payer allows telehealth as part of antepartum packages and the visit meets clinical and documentation standards. Video visits are usually acceptable when permitted; audio-only visits rarely qualify unless payer policy says so. Always confirm policies before counting telehealth toward the 4–6 visit threshold.

Which services are bundled into 59425, and which can be billed separately?

The 4–6 routine prenatal visits themselves (evaluation, counseling, fetal/maternal assessment).
Separately billable: Lab tests, ultrasounds, fetal non-stress testing (59025), vaccines (e.g., Tdap), procedures (e.g., amniocentesis), and problem-oriented services unrelated to routine supervision (with modifier -25 if needed). Be careful not to double-bill for included services.

What are the most common reasons payers deny 59425 claims, and how can I prevent them?

Incorrect visit count (less than 4 or more than 6)

Overlapping global claims from another provider

Incomplete documentation of prenatal elements

Improper telehealth counting without policy support

Wrong date format (span vs last visit date)

What best practices ensure ongoing compliance and clean claims for 59425?

Implement a prenatal visit tracker in your EMR or billing system.

Standardize notes with a prenatal visit template (history, exam, counseling, plan).

Train staff on visit qualification rules and telehealth policies.

Set a claim pre-flight checklist (verify visit count, documentation, transfer status, diagnosis, and date format).

Perform quarterly audits of 59425 claims to confirm correct counts, documentation, and no global overlaps.