CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 59425 RVU and Medicare Payment (2026)
Antepartum care only — 7.8 work RVU, about $574.83 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 7.8
- PE RVU (non-facility)
- 7.18
- PE RVU (facility)
- 1.7
- MP RVU
- 2.23
- Office payment
- $574.83
- Facility payment
- $391.79
How the payment is calculated
Total RVU is work plus practice expense plus malpractice, each adjusted by its GPCI factor, then multiplied by the conversion factor. For 59425 in a non-facility setting with national GPCI: (7.8 + 7.18 + 2.23) × $33.4009 ≈ $574.83. The same code in a facility setting pays about $391.79 because facility PE RVU (1.7) replaces office PE RVU.
What changes by locality
GPCI moves 59425 non-facility payment from $504.89 to $700.66 across CMS localities — from Arkansas to Nyc Suburbs/long Island. Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Checking a different code or locality? Open the full RVU calculator to run any of the 7,790 CPT/HCPCS codes with your own GPCI factors.
Frequently asked questions
What is the 2026 work RVU for CPT 59425?
7.8. Work RVU measures physician time, skill, and intensity — it does not change by setting or locality. Total payment adds practice expense and malpractice RVUs plus the conversion factor.
How much does Medicare pay for CPT 59425 in 2026?
About $574.83 non-facility ($391.79 facility) at national GPCI with the 2026 $33.4009 conversion factor. Your locality GPCI moves the number — see the range above.
Does the work RVU change between office and facility?
No. Work RVU (7.8) and malpractice RVU stay fixed; only practice expense changes (7.18 office vs 1.7 facility). That is the entire office-vs-facility payment gap.