Code Description

CPT code 59025 describes a fetal non-stress test (NST). This is a common antepartum test performed to monitor fetal well-being by measuring the fetal heart rate in response to its movements. The test is typically conducted during the third trimester for high-risk pregnancies or when there is concern for fetal distress. The procedure involves external fetal heart rate monitoring without inducing contractions. CPT 59025 covers the setup, monitoring, and interpretation of the test.

Purpose

The purpose of CPT 59025 is to evaluate fetal health by assessing heart rate patterns and responsiveness. It helps detect fetal hypoxia, distress, or other complications to guide obstetric management and ensure timely interventions if necessary.

Clinical Scenarios Where CPT 59025 is Applicable

High-risk pregnancies such as preeclampsia, diabetes, or decreased fetal movements
Post-term pregnancies requiring fetal surveillance
Assessment of fetal well-being in cases of intrauterine growth restriction (IUGR) or other concerns
Monitoring fetal status in pregnancies complicated by hypertension or placental insufficiency

Procedure Overview

Patient is positioned comfortably, usually in a semi-recumbent or lateral position.
Application of an external fetal heart rate monitor and a tocodynamometer to the abdomen
Continuous monitoring of fetal heart rate and movements for at least 20 minutes
Documentation of reactive or non-reactive fetal heart rate patterns based on established criteria

Documentation Requirements For Fetal Non-Stress Test

Start and end time of the NST procedure.
Indications for testing and clinical context
Detailed interpretation of fetal heart rate patterns and any abnormalities
Patient response and any follow-up recommendations

Billing and Reimbursement Tips Under The CPT Code 59025

CPT 59025 should be billed once per session, regardless of duration, unless medically necessary to repeat
Verify payer policies on the number of allowable NSTs per pregnancy.
Use appropriate modifiers when billing for services alongside other antepartum testing or procedures performed on the same day.
Ensure clinical documentation justifies the medical necessity of the test to avoid denial.s

Medicare Coverage and Reimbursement for CPT 59025

Medicare generally covers CPT 59025 when medically necessary as part of antepartum fetal surveillance. Reimbursement rates vary by locality and are determined by the Medicare Physician Fee Schedule. Providers should confirm coverage and payment with their local Medicare Administrative Contractor. Documentation of medical necessity and detailed interpretation support proper reimbursement.

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At BillingFreedom, we specialize in obstetric billing, including CPT 59025 fetal monitoring. Our certified billing professionals ensure precise coding and thorough documentation to:

Ensure accurate coding and documentation to reduce denials.
Maximize reimbursements through compliant claims submission.s
Navigate payer-specific policies for fetal testing.
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