Specialties
OB/GYN Billing Services
Obstetric care is billed as a package that can take most of a year to complete, then often has to be unpacked: a patient changes insurance mid-pregnancy, transfers to another practice, or delivers with a partner from a different call group. Gynecology adds office procedures, preventive visits with their own Medicare codes, and contraception that plans must cover.
- Global obstetric claims built from the full prenatal record at delivery
- Split antepartum, delivery and postpartum billing when care was shared
- IUD and implant insertion billed with the device and its HCPCS code
How the global obstetric package works
A global obstetric code covers routine antepartum visits, the delivery and routine postpartum care, and it is billed once, usually after the delivery. Prenatal visits are tracked along the way, often with zero-charge codes, so the practice can prove the full package was provided when the global claim goes out. The maternity codes are also being restructured, as CMS's latest proposed physician fee schedule describes, so we apply the codes in effect on each date of service.
Several things fall outside the package and are billed separately: ultrasounds, lab work, and visits for problems unrelated to routine pregnancy care or for complications such as hyperemesis or preterm labor, which are billed as problem-oriented visits with a pregnancy-related diagnosis.
Gynecology runs on different rules. Well-woman visits use the age-banded preventive codes for commercial patients, while Medicare covers a pelvic and breast exam and Pap collection on its own schedule with separate HCPCS codes. Procedures such as colposcopy, endometrial biopsy and LEEP each have their own codes and 0-day global periods.
When the global package has to be split
Common situations in which a single global code is wrong, and what is billed instead.
| Situation | What happened | How it is usually billed |
|---|---|---|
| Patient transfers in late | Your practice provides only part of the prenatal care, then the delivery and postpartum care. | Antepartum visits by count, plus delivery with postpartum care. |
| Patient transfers out | Prenatal care with you, delivery elsewhere. | Antepartum-only code by number of visits, or E/M visits if fewer than four. |
| Different group delivers | An on-call physician outside your group performs the delivery. | Each practice bills only the parts it provided. |
| Same group delivers | A partner in your own group performs the delivery. | Generally still one global claim for the group. |
| Insurance changes mid-pregnancy | Care is covered by two different plans. | Each plan is asked how it wants its share of the care billed, because one global claim to either plan usually fails. |
OB/GYN codes for pregnancy, ultrasound, procedures and LARC
Code families an OB/GYN practice uses most. Confirm against current CPT, HCPCS and payer policy.
| Codes | Service | Billing notes |
|---|---|---|
| 59400, 59510, 59610, 59618 | Global care: vaginal delivery, cesarean delivery, VBAC, and cesarean after a previous cesarean. | Includes routine antepartum and postpartum care. |
| 59425, 59426 | Antepartum care only: 4 to 6 visits, and 7 or more visits. | With fewer than 4 visits, prenatal care is billed with E/M codes instead. |
| 59409, 59514, 59410, 59515, 59430 | Delivery only, delivery with postpartum care, and postpartum care only. | Used when the global package is split between practices. |
| 76801 to 76817 | Obstetric ultrasound: first trimester, after first trimester, detailed fetal anatomy, limited, and transvaginal. | Billed outside the global package; the detailed anatomic study needs documented medical necessity. |
| 57452 to 57461, 58100 | Colposcopy with or without biopsy, LEEP, and endometrial biopsy. | 0-day global periods; same-day visits need a separately documented problem for modifier 25. |
| G0101, Q0091 | Medicare pelvic and breast exam, and Pap smear collection. | Covered on Medicare's screening schedule, more often for high-risk patients. |
| 58300, 58301, 11981 to 11983 | IUD insertion and removal, and contraceptive implant insertion, removal, and removal with reinsertion. | The device is billed separately with its HCPCS J-code when the practice supplies it. |
CPT is a registered trademark of the American Medical Association.
Official sources: CMS NCCI Policy Manual, chapter 7 (obstetric package) (external site), South Dakota Medicaid: obstetrical services billing manual (external site), Federal Register: CY 2027 physician fee schedule proposed rule (maternity codes) (external site), CMS Claims Processing Manual, chapter 18 (G0101 and Q0091) (external site), CMS: ACA implementation FAQs part 64 (contraceptive coverage) (external site), CMS: HCPCS quarterly file (external site), CMS: relative value file (external site), CMS coverage database: article A52453 (external site), CMS coverage database: article A58559 (external site)
Managing a pregnancy episode from first visit to delivery claim
Step 1: Open an obstetric episode at the first visit
Coverage, estimated delivery date and expected delivering provider are recorded when prenatal care starts.
Step 2: Track every prenatal visit
Visits are logged against the episode so the global or split claim can be built from the record.
Step 3: Re-verify coverage during pregnancy
Insurance is checked again before delivery, since a mid-pregnancy change decides how the package is billed.
Step 4: Bill at delivery with the right structure
Global, split or itemized billing is chosen from who provided which part of the care.
OB/GYN denials and how they start
Global billed after a change of insurance
The patient changed plans during pregnancy, so the new plan will not pay for antepartum care given under the old one.
Global billed when care was shared
A transfer or another practice's delivery means split codes were needed, not a global claim.
Routine pregnancy visits billed separately
Prenatal visits that belong in the package billed as E/M visits, which payers deny as included.
Ultrasound frequency or necessity
Repeat or detailed ultrasounds without the documented indication the payer requires.
Device not on the claim
IUD or implant insertion billed without the device, or a device billed that came from a pharmacy.
No authorization for gynecologic surgery
Hysterectomy and some other gynecologic procedures commonly need prior authorization.
Contraception and LARC coverage
Most non-grandfathered health plans must cover at least one contraceptive method in every category of the HRSA-supported guidelines for women, with no cost sharing. That makes coding precise: the insertion procedure, the device by its HCPCS code, and the contraceptive management diagnosis all need to line up for the claim to pay without the patient being charged.
Practices that stock IUDs and implants carry the device cost until the claim pays, so device inventory is matched to insertions and claims every month. Where a plan supplies the device through a specialty pharmacy instead, only the insertion is billed.
Frequently asked questions
When do we bill the global obstetric code?
Usually after the delivery, once the package of antepartum care, delivery and postpartum care is complete or nearly complete. Some payers want it after the postpartum visit.
What if the patient changed insurance during pregnancy?
This is one of the most common obstetric denials: a global claim sent to the new plan includes care it never insured. We re-verify coverage during pregnancy, log which plan covered each prenatal visit, and confirm with each plan how it wants its part billed, which usually means split codes instead of one global claim.
Are ultrasounds included in the global package?
No. Obstetric ultrasounds are billed separately, with a documented reason for each study, and payers often limit how many routine scans they will cover.
How should IUD insertion be billed?
With the insertion code, the device's HCPCS code if the practice supplied it, and a contraceptive management diagnosis. Removal and reinsertion have their own codes.
Can we bill a problem visit during a well-woman exam?
Yes, when a separate problem needs significant extra work and is documented separately, with modifier 25 on the problem visit.
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Check your obstetric and LARC billing
A free audit reviews global and split obstetric claims, ultrasound denials and contraception billing in your OB/GYN practice.