OBGYN Billing — Global Maternity Packages, Simplified

Proven Results

• 27% Average Revenue Increase
• 96.3% First-Pass Claim Rate
• 41% Reduction in Denials
• 14 Days Faster Payment Collection

Common Billing Challenges

Global Maternity Package Billing

Maternity care bundles antepartum, delivery, and postpartum services into one global package requiring careful tracking and proper delivery date billing.

Delivery & Cesarean Coding Complexity

Vaginal vs cesarean delivery coding, VBAC procedures, and complications require precise CPT code selection based on delivery method and maternal conditions.

Antepartum Visit Tracking

Tracking antepartum visits to determine if billing globally or individually requires precise visit counting and complication monitoring.

Device Insertion Billing

IUD, Nexplanon, and other contraceptive device billing requires proper supply codes, insertion procedure codes, and payer-specific coverage verification.

Family Planning Services Coverage

Different payers have varying coverage for contraception, sterilization, and abortion services requiring knowledge of state-specific regulations.

Ultrasound & Fetal Monitoring

OB ultrasounds have specific CPT codes based on trimester and type, with medical necessity requirements for non-routine imaging.

Our Solutions

Maternity Billing Specialists

Our team includes certified coders with specialized training in OB/GYN procedures, global maternity packages, and women\

• Expert global package vs individual visit determination
• Accurate delivery and complication coding
• Proper antepartum visit tracking
• Maximized maternity reimbursement

Global Package Tracking Systems

Advanced systems automatically track antepartum visits, delivery dates, and postpartum care to ensure proper global billing.

• Automated visit counting and tracking
• Delivery date monitoring and alerts
• Global vs individual billing optimization
• Reduced global package billing errors

Delivery & Surgical Coding Expertise

Specialized knowledge of vaginal and cesarean delivery coding, including complications, VBAC procedures, and gynecologic surgeries.

• Accurate delivery method coding
• Complication and co-morbidity capture
• Gynecologic surgery billing (hysterectomy, etc)
• Higher reimbursement through proper coding

Device & Contraceptive Billing Support

Expert billing for IUDs, implants, and contraceptive devices with proper supply and insertion procedure coding.

• Device supply code expertise (J codes)
• Insertion procedure billing
• Payer coverage verification
• Improved device reimbursement

Specialized Services

Prenatal Care Global Billing

Complete management of global maternity packages including antepartum visits, delivery, and postpartum care.

• Global OB package (59400, 59510)
• Antepartum visit tracking
• Delivery date billing
• Postpartum care inclusion

Delivery & C-Section Procedures

Expert coding for vaginal delivery, cesarean section, VBAC, and delivery complications with proper CPT code selection.

• Vaginal delivery (59400)
• Cesarean delivery (59510)
• VBAC procedures (59610)
• Delivery complications

Gynecological Surgery Billing

Specialized billing for hysterectomy, laparoscopic procedures, and other gynecologic surgeries.

• Hysterectomy procedures
• Laparoscopic surgery
• Endometrial ablation
• Pelvic floor repair

Contraceptive Device & Services

Complete billing support for IUD insertion, Nexplanon, tubal ligation, and family planning services.

• IUD insertion (58300)
• Nexplanon placement (11981)
• Tubal ligation
• Contraceptive counseling

Common CPT Codes Reference

Key codes include 59400 (Routine obstetric care including antepartum, vaginal deliver), 59510 (Routine obstetric care including antepartum, cesarean delive), 59610 (Routine obstetric care including antepartum, VBAC delivery, ), 59430 (Postpartum care only (separate procedure)), 58661 (Laparoscopy, surgical; with removal of adnexal structures), 58262 (Vaginal hysterectomy, uterus 250g or less), 58552 (Laparoscopic vaginal hysterectomy, uterus 250g or less), 57454 (Colposcopy with biopsy(s) and ECC), 76805 (Ultrasound, pregnant uterus, real time with image documentat), 59025 (Fetal non-stress test). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.

Expert Billing Insights

Global Maternity Package Billing and Split OB Care

The OB global package (59400, 59510) bundles all routine antepartum visits (beginning at 13 weeks), delivery, and postpartum care into one all-inclusive fee. Split OB care occurs when multiple providers share obstetric care — each bills individually for the visits they provide using component codes (59425 for 4–6 antepartum visits, 59426 for 7+ visits) rather than the global package. When a new provider takes over care, the delivering provider typically bills only the delivery code. Accurate billing requires knowing which component codes to use and when.

• Antepartum component: 59425 (4–6 visits) or 59426 (7+ antepartum visits)
• Delivery only (vaginal): 59409; delivery only (C-section): 59514
• Postpartum care only: 59430 — use when delivery was by different provider
• Bill the global package ONLY when one provider provides all three phases of care

Gynecologic Surgery: Global Periods, Modifiers, and Laparoscopic Coding

Gynecologic surgical procedures carry 90-day global periods during which most related follow-up care is bundled. Separately billable services within the global period require careful modifier usage (Modifier 24, 79, 58). Laparoscopic versus open procedure coding must be precise — upcoding an open procedure for a laparoscopic one (or vice versa) is a compliance risk. Robotic-assisted procedures have specific HCPCS and CPT coding requirements.

• Modifier 24: unrelated E/M during global period; Modifier 79: unrelated procedure
• Modifier 58: staged or related procedure during global — payable
• Document laterality for adnexal procedures (bilateral vs. unilateral)
• Robotic-assisted procedures: S2900 HCPCS code may be reported with the primary CPT code

Preventive GYN Billing: Pap Smears, Contraception, and Wellness Visits

Preventive gynecology services create complex billing scenarios because preventive E/M codes and diagnostic codes cannot typically be billed on the same day without modifier 25. Annual well-woman exams (G0101 for Medicare beneficiaries; 99395–99397 for commercial payers) must be distinguished from problem-focused GYN visits. Contraceptive counseling and device insertion have separate billing codes that can be appended to preventive or problem-oriented visits.

• Medicare well-woman: G0101 (cervical cancer screening) + Q0091 (Pap collection)
• Commercial well-woman: 99395 (18–39), 99396 (40–64) — preventive E/M
• IUD insertion: 58300 (insertion) + device supply code; IUD removal: 58301
• Modifier 25 required when billing both a preventive and problem-focused visit same day

Payer-Specific Billing Tips

Medicare Part B

• Medicare covers GYN-only preventive care with G0101 (cervical screen) annually
• Medicare does NOT cover most obstetric care — patients in childbearing age rarely have Medicare
• Medicare Advantage plans may have different GYN benefit structures — verify per plan
• Pelvic/breast exam covered under G0101 — must be performed by enrolled provider

Medicaid

• Medicaid is the largest payer for obstetric care in the US — global OB rates vary by state
• Many states have enhanced Medicaid OB rates for high-risk pregnancies (perinatology)
• Postpartum coverage extensions (up to 12 months) were enacted in many states — verify enrollment
• FQHC-qualified OB practices bill at enhanced prospective payment rates

Commercial Payers (ACA Plans)

• ACA requires maternity care coverage — all marketplace plans must cover OB global package
• Deductibles and out-of-pocket costs for maternity care vary widely — collect at time of service
• Fertility treatment coding (IUI, IVF) has separate and often limited coverage — verify benefits
• High-risk OB care billed with appropriate ICD-10 high-risk diagnosis codes (O09.x series)

OB Global Billing Pitfalls

• Do not bill individual antepartum visits after billing the global package — causes duplicate claim issues
• Document all risk factors (gestational diabetes, preeclampsia) to support high-risk billing
• Ultrasounds performed in-office during OB care may be separately billable — verify per payer
• Non-stress tests and biophysical profiles are separately billable in high-risk pregnancies

Related Billing Resources

• Pediatrics Billing
• Urology Billing
• Oncology Billing
• Eligibility Verification
• Medical Coding Services
• CPT Codes Reference Guide
• ICD-10 Codes Reference

Key Services

• OBGYN billing
• obstetrics billing
• gynecology billing
• maternity billing
• women's health billing
• prenatal care billing