Most of what an obstetric practice bills for a pregnancy goes out as one claim, months after the first visit, and it only holds together if the patient keeps the same insurance and the same practice the whole way through.
Key Takeaways
- The global obstetric codes (59400, 59510, 59610, and 59618) cover routine antepartum care, delivery, and postpartum care, and they’re billed once after delivery.
- When the same practice doesn’t provide all of the care, the package is split into antepartum, delivery, and postpartum codes.
- Antepartum care is billed as 59425 for four to six visits or 59426 for seven or more. One to three visits bill as E/M services.
- Ultrasounds, non-stress tests, and visits for complications aren’t part of the global package and are billed separately.
- Most plans must cover contraception and well-woman preventive care without cost-sharing under the ACA.
The Global Obstetric Package
When one practice provides all of a patient’s routine pregnancy care, it bills a single global code after delivery. 59400 covers a vaginal delivery, 59510 a cesarean delivery, 59610 a vaginal birth after cesarean, and 59618 a cesarean after an attempted VBAC. Each includes the routine prenatal visits, the delivery itself, and routine postpartum care. The date of service on the claim is the delivery date.
Several services stay outside the package. Initial and confirmatory pregnancy visits before the decision to start prenatal care, visits for unrelated problems, and extra visits for pregnancy complications such as preeclampsia or gestational diabetes can be billed separately with the diagnosis for that complication. Ultrasounds and fetal non-stress tests (59025) are billed separately as well.
Many Medicaid programs and some commercial plans don’t follow the global model and pay prenatal visits individually, or require a notification of pregnancy at the first visit. The contract decides which method applies, and our guide to which CPT codes are used in OBGYN billing lists the full code set.
Splitting the Global
A patient who changes insurance, moves, or transfers care partway through a pregnancy can’t be billed under one global code by any single practice. Each practice bills only what it provided. Antepartum care bills as 59425 for four to six visits or 59426 for seven or more, and one to three visits bill as office E/M visits. Delivery-only codes include 59409 for vaginal delivery and 59514 for cesarean delivery, and delivery-plus-postpartum codes include 59410 and 59515. Postpartum care alone bills as 59430.
When the patient’s insurance changes but the practice stays the same, each insurer is billed for the care given while the patient was covered by that plan. The antepartum visits are split by coverage date, and the delivery and postpartum care go to the plan in effect at delivery. Tracking coverage dates from the first prenatal visit avoids rebuilding the claim history months later.
Prenatal Ultrasounds and Testing
Obstetric ultrasounds are billed separately from the global package. A first-trimester ultrasound bills as 76801, a standard second- or third-trimester ultrasound as 76805, and a detailed fetal anatomy exam as 76811, which payers usually expect to come from maternal-fetal medicine or a practice with that expertise. Follow-up ultrasounds bill as 76816, transvaginal ultrasounds as 76817, and limited exams as 76815.
Payers limit routine ultrasounds in a low-risk pregnancy, often to one or two, and expect a documented clinical reason for each additional study. The diagnosis on each ultrasound claim has to support it. A routine supervision-of-pregnancy code alone rarely supports a third ultrasound. Practices that offer prenatal genetic screening can see our genetic testing page for how labs bill those tests.
Gynecology and Preventive Care
Well-woman visits for commercial patients bill under the age-based preventive codes (99384 to 99387 for new patients, 99394 to 99397 for established patients), which most plans cover without cost-sharing. Medicare doesn’t cover a routine physical but does cover a screening pelvic and breast exam (G0101) and Pap specimen collection (Q0091) every 24 months, or every 12 months for patients at high risk. When a problem is addressed at the same visit, it bills as a separate E/M with modifier 25, and the patient’s usual cost-sharing applies to it.
Contraception is billed as the procedure plus the device. IUD insertion bills as 58300 with the device’s J-code, and implant insertion bills as 11981 with J7307. Most plans have to cover FDA-approved contraception without cost-sharing. Common office procedures include colposcopy (57452 to 57456, depending on biopsy or curettage), LEEP (57460 and 57461), and endometrial biopsy (58100). Our guide to using modifier 25 correctly covers same-day preventive and problem visits.
Gynecologic Surgery
Hysterectomy codes depend on the approach and, for laparoscopic and vaginal cases, the weight of the uterus. Laparoscopic total hysterectomy bills as 58570 to 58573, split at 250 grams and by whether the tubes and ovaries were removed, so the pathology report’s uterine weight has to match the code. Most elective gynecologic surgeries need prior authorization, and the authorization has to match the approach and code billed.
Major gynecologic procedures carry a 90-day global period. The decision-for-surgery visit the day before or of the procedure takes modifier 57, and unrelated visits during the global period take modifier 24.
OBGYN Credentialing
Physicians and privileges
OBGYNs certify through the American Board of Obstetrics and Gynecology, which requires ongoing maintenance of certification. Payers verify board status, licensure, DEA registration, and malpractice history, often with closer review of obstetric claims history. Each hospital grants labor and delivery privileges separately, and a physician who delivers at a hospital where privileges have lapsed can’t bill the delivery.
Midwives, NPs, and PAs
Certified nurse-midwives enroll with Medicare and most payers under their own NPI, and Medicare pays them at 100% of the physician fee schedule. Women’s health NPs and PAs need their own enrollment as well. Medicaid covers a large share of births, and most states now extend Medicaid coverage for 12 months after delivery, so midwives and physicians need enrollment with each Medicaid managed care plan in their market. Until each provider is approved, their claims can’t be billed, which is why you can’t bill what you can’t credential.
OBGYN Billing FAQs
What does the global obstetric package include?
Routine antepartum visits, the delivery, and routine postpartum care. Ultrasounds, non-stress tests, and visits for pregnancy complications or unrelated problems are billed separately.
When is the global OB code billed?
After delivery, with the delivery date as the date of service. Some Medicaid programs and commercial plans pay prenatal visits individually instead.
How is OB care billed when a patient changes insurance mid-pregnancy?
Each insurer is billed for the care given during its coverage. Antepartum visits are split by coverage date using 59425, 59426, or E/M codes, and the delivery and postpartum care go to the plan in effect at delivery.
How are antepartum visits billed outside the global package?
59425 for four to six visits, 59426 for seven or more, and office E/M codes for one to three visits.
Does Medicare cover a well-woman exam?
Medicare covers a screening pelvic and breast exam (G0101) and Pap collection (Q0091) every 24 months, or every 12 months for patients at high risk. It doesn’t cover a routine physical.
How is IUD insertion billed?
The insertion bills as 58300, and the device bills separately with its own J-code. Most plans cover contraception without cost-sharing.
OB/GYN Billing and Credentialing with Medwave
Obstetric care is billed as a package, and most OB denials come from not knowing what’s inside it. Medwave bills global obstetric codes when one practice provides all the care, splits antepartum, delivery, and postpartum when it doesn’t, and bills complications outside the package when the record supports it. Our billing team runs OB/GYN at a 98% clean claim rate.
OB/GYNs need hospital privileges for deliveries on top of payer enrollment, and our credentialing team runs both, averaging 85 days. Medicaid pays for a large share of US births, so our payer contracting work often starts with Medicaid managed care rates.
Groups adding a delivery hospital can reach us through the form below.