OB/GYN Billing Services: Global OB, Delivery and Gyn
OB/GYN billing pays when the global obstetric package is billed once, split only when your group did not provide all the care, and coded with the right pregnancy diagnoses and modifiers. This page covers the physician and midwife claim: package codes, ultrasound, ICD-10-CM, gyn procedures, Medicaid and the denials OB/GYN practices see most.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026Standards We Work Under
In short: maternity care is paid as a package covering prenatal visits, delivery and postpartum care, and ultrasound and unrelated visits are billed on top. Split the package only when the group did not provide every part, and expect Medicaid to cover a large share of births under its own state rules.
The Codes an OB/GYN Practice Bills Most
| Code | Description | Notes |
|---|---|---|
| 59400 | Routine maternity package: prenatal care, vaginal delivery and postpartum care | Global MMM. Not for fewer than the payer's visit minimum |
| 59510 | Routine maternity package: prenatal care, cesarean delivery and postpartum care | Global MMM |
| 59409 | Vaginal delivery only | Used when a group does only the delivery |
| 59410 | Vaginal delivery with postpartum care | No prenatal care by the group |
| 59425 | Prenatal care only, 4 to 6 visits | Count set by payer |
| 59426 | Prenatal care only, 7 or more visits | |
| 76805 | Obstetric ultrasound at 14 weeks or later, single fetus | Not in the package. 26 and TC apply |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast exam | Medicare, paid after at least 23 months since the last covered exam unless an exception applies |
| Q0091 | Screening Pap smear: obtaining, preparing and conveying the specimen | Medicare, every 2 years low risk, yearly high risk |
| Z3A | ICD-10-CM weeks of gestation, category Z3A | Add to Chapter 15 or Z34 codes, not postpartum |
Modifiers That Matter
| Modifier | Use |
|---|---|
| 22 | Increased services, such as a complicated delivery or high-risk prenatal care. NCCI says the work must be substantially more extensive than usual. Attach notes |
| 25 | Significant, separately identifiable visit on the same day as a procedure or screening service, or a visit unrelated to the pregnancy |
| 26 / TC | Professional read (26) or technical component (TC) on obstetric ultrasound |
| 52 | Reduced services. Iowa Medicaid uses it on a global code for 4 to 6 antepartum visits. Payer specific |
| 57 | Decision for major surgery, global 090 days |
| GA | Advance beneficiary notice on file, such as Q0091 billed before Medicare's frequency limit |
Payer Rules to Know
| Payer | Rule |
|---|---|
| Medicare | File within 1 calendar year of the date of service (42 CFR 424.44(a)(1)). Screening Pap smear every 2 years for low-risk patients, yearly for high risk (Chapter 18, section 30.5). Maternity codes carry a global period of MMM on the fee schedule. |
| Medicaid | Pregnancy-related services are required (42 CFR 440.210(a)(2)). Federal limit of 12 months from the date of service for claims (42 CFR 447.45(d)(1)). Visit counts, modifiers and global code use come from the state manual. |
| Commercial plans | Women's preventive services in HRSA guidelines are covered without cost sharing (45 CFR 147.130(a)(1)(iv)). Filing limits, package rules and modifier edits come from the contract. |
Top Denials in Ob/Gyn Billing Services: Global Ob, Delivery and Gyn
| Reason | Why it happens | Our fix |
|---|---|---|
| CO-97, bundled into another service | The payer treats a visit or test as part of a package or procedure already paid, such as prenatal visits billed beside 59400. | Remove visits that belong to the package. Add modifier 25 only for a separate, documented problem. |
| CO-16, missing information | The claim lacks data, such as a trimester character, weeks of gestation or a delivery date. | Correct the claim using the remark code and resubmit. |
| CO-4, code inconsistent with modifier | A modifier does not fit the code, such as 26 on an ultrasound the group did not read. | Correct the modifier and resubmit. |
| CO-29, time limit for filing expired | The claim reached the payer after its deadline, often a package held until postpartum care ended. | Appeal only with proof of timely submission. Track the limit from the date of service. |
| CO-49, routine or preventive exam not covered | The payer says a preventive visit or screening is not covered under the member's plan. | Check the plan's preventive benefit and 45 CFR 147.130, then appeal with the diagnosis and visit purpose. |
| CO-151, information does not support the frequency | The payer says the services billed exceed what the record supports, such as a second screening within the limit. | Check the last paid date. Appeal with documented high-risk status, or bill with an ABN where Medicare applies. |
What Does OB/GYN Billing Cover?
OB/GYN billing covers two different revenue streams on one claim form: maternity care, which Medicare and most payers pay as a package, and gynecology, which is billed visit by visit and procedure by procedure. The practice bills both on the CMS-1500, and the delivering hospital bills its own facility claim on the UB-04.
Under the 2026 NCCI Policy Manual, Chapter VII, section G, the total obstetrical packages such as 59400 and 59510 include antepartum care, the delivery and postpartum care. Practices lose money when they add services the package already pays, or split one when they should not.
Which Codes Does an OB/GYN Practice Bill Most, and Does Medicare Pay Them?
An OB/GYN practice bills four global package codes, the split codes behind them, obstetric ultrasound, office visits and a short list of gynecology procedures. In the CMS Physician Fee Schedule file RVU26D, the October 2026 release, every code in the table carries payment status A, so Medicare pays it under the fee schedule.
Maternity codes carry a global period of MMM in that file. CPT descriptors belong to the AMA, so the table paraphrases them. The package codes have their own pages: 59400 and 59510, and the ultrasound code 76805.
What Does the Global OB Package Include, and What Is Billed on Top of It?
The global package covers antepartum care, the delivery and postpartum care, and nothing else. Under NCCI Policy Manual Chapter VII, section G.1, it does not include ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions or additional frequent visits caused by high-risk conditions.
| Service | Rule |
|---|---|
| Routine antepartum visits and urinalysis | Included. Urinalysis in antepartum care is not separately reportable |
| Ultrasound, amniocentesis, genetic screening | Not included. Billed separately |
| Visits for conditions unrelated to the pregnancy | Not included. Billed as visits with modifier 25 |
| Extra visits caused by a high-risk condition | Not included under the NCCI manual. Many payers want modifier 22 on the package or a separate high-risk code instead, so check each contract |
| Wound repair 12001 to 13153 to close the surgical incision | Not reported for a code with an MMM global |
NCCI section G.4 adds that maternity procedures are subject to the global surgery and anesthesia rules, because a cesarean resembles a surgical procedure with a 000, 010 or 090-day global. The same codes bundled into those surgeries are bundled into the MMM group.
One group provides all of a patient's care, including a 20-week ultrasound and a visit for a urinary infection. The claim carries 59400 once, 76805 on its own line, and the infection visit with modifier 25. Routine prenatal visits are never billed one by one.
When Should the Global Package Be Split into Antepartum, Delivery and Postpartum Codes?
Split the package when one group does not provide all three parts of the care. The delivery-only codes are 59409 (vaginal), 59514 (cesarean), 59612 (vaginal after a prior cesarean) and 59620 (cesarean after an attempted vaginal delivery after a prior cesarean). The antepartum-only codes are 59425 and 59426, and the postpartum-only code is 59430. All of these are status A in RVU26D.
The visit-count thresholds below come from one state Medicaid agency. The Iowa HHS guide says to bill the global code when one practitioner or group provides all components, including 4 or more antepartum visits.
| What the group provided | What Iowa Medicaid says to bill |
|---|---|
| Fewer than 4 antepartum visits, delivery and postpartum care | The delivery-with-postpartum code (such as 59410 or 59515) plus office visits with modifier 25 |
| 4 to 6 antepartum visits, delivery and postpartum care | The global code with modifier 52, reduced services |
| More than 14 medically necessary antepartum visits | The global code with modifier 22 and the visit notes attached |
| Antepartum care only: 4 to 6 visits, or 7 or more | 59425, or 59426 |
| Delivery only | 59409, 59514, 59612 or 59620 |
| Delivery and postpartum care, no antepartum care | 59410, 59515, 59614 or 59622 |
| Postpartum care only, with no part in the delivery | 59430 |
The same guide bills antepartum and delivery-only codes together only when postpartum care was not provided. Other payers set different counts and modifiers, so never copy one payer's rule to another.
How Do We Bill a Delivery When the Patient Transfers Care?
Bill what your group actually did. If a patient joins your practice late, bill the delivery and postpartum code. If she leaves before delivery, bill antepartum care only, or visits if the count is low. Do not bill the global code and then adjust it, because the payer then sees two claims for one package.
In teaching hospitals, Medicare Claims Processing Manual Chapter 12, section 100.1.6 applies. To bill a global procedure, the teaching physician must be present for the minimum number of visits the code specifies. If the teaching physician was involved only at delivery, the delivery-only code applies.
How Do We Bill an Obstetric Ultrasound with a Visit?
Bill the ultrasound on its own line, outside the package. Under NCCI Chapter VII, section G.1, ultrasound is not part of the global OB package, and in RVU26D codes such as 76801, 76805, 76811, 76815 and 76816 are status A with a professional component (modifier 26) and a technical component (TC).
An office visit on the same day as an ultrasound needs separate work. For a patient who is not pregnant, a visit with a pelvic ultrasound such as 76830 or 76856 needs a medical reason for the visit that is separate from the scan.
How Do We Code Pregnancy with ICD-10-CM, Including Z3A Weeks of Gestation?
Pregnancy cases use Chapter 15 codes, O00 to O9A, and these have sequencing priority over codes from other chapters. The CDC FY2027 ICD-10-CM Official Guidelines, effective October 1, 2026, also say they are used only on the mother's record.
| Situation | Rule |
|---|---|
| Routine prenatal visit, no complications | Z34 (supervision of normal pregnancy) first-listed, and not used with other Chapter 15 codes |
| Prenatal visit for a high-risk pregnancy | O09 (supervision of high-risk pregnancy) first-listed, with Chapter 15 codes after it |
| Weeks of gestation | Z3A may be added for more information. Not for abortive outcomes (O00 to O08), elective termination (Z33.2) or postpartum conditions |
| Counting weeks | Completed weeks only: 39 weeks and 6 days is reported as 39 |
| Trimester character | Based on the provider's documentation of the trimester or number of weeks for this encounter |
| Normal delivery | O80 is always the principal diagnosis and not used if any other Chapter 15 code is needed |
| Outcome of delivery | A Z37 code on every maternal delivery record, always secondary. Z37.0 is the only outcome code used with O80 |
The guidelines define the postpartum period as beginning immediately after delivery and continuing for six weeks. Routine postpartum care uses Z39, the encounter for maternal postpartum care and examination.
How Do We Bill Gynecology Procedures and Visits on the Same Day?
A gyn visit and a procedure can both be billed on one date only if the visit is significant and separately identifiable. Under NCCI Chapter I, a significant and separately identifiable E/M service unrelated to the decision to perform a minor surgical procedure is reportable with modifier 25, and the two services do not require different diagnoses.
Chapter VII, section E, adds gynecology-specific edits. A pelvic examination done as part of a gynecologic procedure, or to confirm it, is not separately reportable.
| Code | Plain-words descriptor | Global | Billing note |
|---|---|---|---|
| 58301 | Remove an intrauterine device | 000 | Visit needs modifier 25 and separate work |
| 57454 | Cervical biopsy and curettage under colposcope | 000 | Colposcopy is bundled when done to confirm a lesion before surgery (NCCI VII.E.5) |
| 57460 | Cervical biopsy with loop electrode excision | 000 | Document the colposcopic finding |
| 58558 | Hysteroscopy with biopsy | 000 | Diagnostic hysteroscopy is included in surgical hysteroscopy |
| 58150 | Total hysterectomy | 090 | Decision visit may carry modifier 57 |
See modifier 25 for the full rule.
How Do We Bill Well-Woman Exams, Pap Smears and Screening Codes?
Medicare pays for a screening pelvic and breast exam with G0101 and for obtaining a screening Pap smear with Q0091. Both are status A in the October 2026 HCPCS file and RVU26D, and both can be reported with a separate E/M visit only when that visit is a separately identifiable service, with modifier 25 on the visit.
The frequency limits come from Medicare Claims Processing Manual Chapter 18. Section 30.5 says Medicare pays for a screening Pap smear every 2 years for low-risk patients and every year for high-risk patients. Section 40.2 says a screening pelvic exam is paid only after at least 23 months have passed following the month of the last covered exam, unless the patient qualifies for the higher-risk exception.
For commercial plans, the rule is 45 CFR 147.130. Group health plans and issuers must cover preventive services without cost sharing, including, for women, additional preventive care and screenings provided for in HRSA-supported guidelines (paragraph (a)(1)(iv)), and A or B rated USPSTF services. If the service is billed separately from the visit, the plan may charge cost sharing on the visit. If it is not billed separately and is the main purpose of the visit, the plan may not (paragraph (a)(2)).
A preventive exam that turns into a problem visit is the usual denial source. Medicare Chapter 18 allows a separately identifiable E/M with G0101 or Q0091 when it carries modifier 25. Document the problem work apart from the routine exam. CARC 49 is the denial for a routine or preventive exam the payer says is not covered.
Which OB Services Does Medicaid Cover Differently?
Medicaid is required to cover pregnancy-related services, and many OB/GYN practices see a large share of Medicaid births. Under 42 CFR 440.210(a)(2), categorically needy beneficiaries must receive pregnancy-related services, which the rule says include prenatal care, delivery, postpartum care and family planning services.
Under 42 CFR 435.116, the agency must cover pregnant women at or below its state plan income standard, which is at least 133 percent of the federal poverty level.
Postpartum coverage extends past delivery. Under 42 CFR 440.210(a)(3), the extended postpartum period runs through the end of the month in which the 60-day period after the end of pregnancy ends. A CMS maternal health fact sheet says the American Rescue Plan Act gave states an option to extend postpartum coverage to 12 months and the Consolidated Appropriations Act of 2023 made it permanent. Whether a given state has adopted it is a state decision.
Verify eligibility every month, because a patient may move between pregnancy, postpartum and standard coverage. The state manual sets visit counts and modifiers, so the Iowa table above is an example only. See our Medicaid billing guide and Medicare billing guide.
Does the No Surprises Act Apply to OB/GYN Claims and How Are Underpayments Disputed?
Yes, when an out-of-network provider treats a patient in an emergency department, which includes a woman who arrives in labor. Under 45 CFR 149.410(a), a nonparticipating provider must not bill an emergency patient for more than the in-network cost-sharing amount, and the dispute over the payment moves to the plan.
A group covering a labor floor can see many such claims, each with its own deadline. Our No Surprises Act hub explains the steps.
What Are the Most Common Denials in OB/GYN, and How Are They Worked?
The most common OB/GYN denials are bundling (CARC 97), missing information (16), modifier conflicts (4), timely filing (29), preventive exam not covered (49) and frequency (151). A CARC is a claim adjustment reason code, the numeric reason a payer gives on the remittance.
The denial table above gives the fix for each. See denial management.
How We Handle OB/GYN Billing
We code the claim from the chart, send claims within 24 hours of charge entry and work denials within 48 hours. Our certified coders (AAPC and AHIMA) decide whether a pregnancy is billed as a package or split, set the trimester and weeks of gestation from the note, and check gyn procedures against NCCI edits before the claim goes out. Our team has billed for US practices since 2018 and works to a 95% clean claim rate.
Medicaid-heavy practices get automated eligibility checks, because pregnancy and postpartum coverage change by month. For out-of-network labor and delivery claims, we handle eligibility assessment, open negotiation, dispute submission, deadline management, documentation validation and outcome tracking under federal IDR and applicable state pathways, including Texas TDI.
To talk through your practice, book a call. Related: pediatric billing, family medicine billing, anesthesia billing and all specialties.
- CMS Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- NCCI Policy Manual for Medicare Services, 2026 · CMS
- Medicare Claims Processing Manual, Chapter 12 · CMS
- Medicare Claims Processing Manual, Chapter 18 · CMS
- HCPCS Quarterly Update, October 2026 Alpha-Numeric file · CMS
- ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 · CDC / NCHS
- Maternity Billing (Iowa Medicaid, updated 7/6/2023) · Iowa Department of Health and Human Services
- Maternal Health at a Glance, 2024 · Medicaid.gov
- 42 CFR 435.116, Pregnant women · eCFR
- 42 CFR 440.210, Required services for the categorically needy · eCFR
- 42 CFR 424.44, Time limits for filing claims · eCFR
- 42 CFR 447.45, Timely claims payment · eCFR
- 45 CFR 147.130, Coverage of preventive health services · eCFR
- 45 CFR 149.410, Balance billing in cases of emergency services · eCFR
- Claim Adjustment Reason Codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Who We Serve
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does the global OB package include?
It includes antepartum care, the delivery and postpartum care. Under NCCI Policy Manual Chapter VII, section G, it does not include ultrasound, amniocentesis, genetic screening tests, visits for unrelated conditions or extra visits for high-risk conditions. Fetal monitoring, episiotomy and placenta delivery are part of the delivery.
02When can prenatal visits be billed separately?
Bill them separately only when the group does not provide the whole package, or when the visit is unrelated to the pregnancy. The Iowa Medicaid guide, for example, bills visits individually with modifier 25 when there are fewer than 4 antepartum visits. Other payers set other counts, so check each manual.
03How do we bill a delivery when the patient transfers care?
Bill only the parts your group provided. Delivery with postpartum care and no prenatal visits uses 59410, 59515, 59614 or 59622, since the group did not do the prenatal part. Delivery alone uses 59409, 59514, 59612 or 59620. Keep a prenatal flow sheet showing where care changed hands.
04How do we bill an obstetric ultrasound with a visit?
Bill the ultrasound on its own line, because the NCCI manual says ultrasound is not part of the global OB package. Use no modifier when you own the equipment and read the scan, and modifier 26 for the read only. A visit on the same day needs separate work, with modifier 25 where it applies.
05Which OB services does Medicaid cover differently?
Medicaid must cover pregnancy-related services under 42 CFR 440.210(a)(2), and postpartum coverage runs through the month the 60-day period ends. States may extend postpartum coverage to 12 months, an option made permanent in 2023. Billing rules such as visit counts and modifiers come from each state's manual.
06How much does outsourcing OB/GYN billing cost as a percentage of collections?
We charge a percentage of collections. The range is on our pricing page, the one place we publish it. The rate depends on volume, payer mix and scope, such as how many Medicaid deliveries you bill. A call lets us quote against your volume and payers.
07Which codes should an OB/GYN billing team know best?
The four global packages 59400, 59510, 59610 and 59618, and the split codes 59409, 59410, 59425, 59426 and 59430, carry most maternity revenue. Add ultrasound 76801 to 76816, office visits, G0101, Q0091 and common gyn procedures such as 58301 and 57454.
08What are the most common denial reasons in OB/GYN and how are they worked?
The most common are CARC 97 (bundled), 16 (missing information), 4 (modifier conflict), 29 (timely filing), 49 (preventive exam not covered) and 151 (frequency). We work denials within 48 hours, and track each payer's filing window, so a correctable claim is fixed before it times out.
09What documentation does an OB/GYN practice need to support the codes billed?
Keep a prenatal flow sheet with visit dates and the provider for each, the delivery note, and the postpartum visit. Document trimester or weeks for each encounter, the high-risk reason if you bill modifier 22, and a separate problem note for any visit billed with modifier 25 beside a preventive service or procedure.
10How do Medicare and commercial payer rules differ for OB/GYN claims?
Medicare requires filing within one calendar year of the date of service under 42 CFR 424.44(a)(1) and limits screening Pap smears to once every 2 years for low-risk patients. Commercial plans set their own filing limits and package rules by contract, but must cover HRSA-supported women's preventive services without cost sharing under 45 CFR 147.130.
11Does the No Surprises Act apply to OB/GYN claims and how are underpayments disputed?
It applies when an out-of-network provider treats an emergency patient, such as a woman in labor in an emergency department. The patient owes only in-network cost sharing under 45 CFR 149.410(a), and the payment dispute goes to the plan.
Talk to an Ob/Gyn Billing Services: Global Ob, Delivery and Gyn Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.