OB/GYN billing services
Global obstetric packages, mid-pregnancy insurance changes and preventive gynecology visits each follow different rules. We bill each one to the payer's rules for your practice.
Why OB/GYN billing takes specialty knowledge
OB/GYN billing mixes two very different workflows. Obstetric care is usually billed as a global package after delivery, which means months of prenatal visits sit unbilled while the patient is in your care. Gynecology runs on everyday office visits, preventive exams, ultrasounds and in-office procedures like IUD insertions and colposcopies. When a patient changes insurance or transfers in at 24 weeks, the global package no longer fits and the claim has to be broken into antepartum, delivery and postpartum codes.
SFA Solutions tracks each pregnancy from the first visit so prenatal services are accounted for when the delivery claim goes out. Our coders know which payers want global billing, which want trimester or visit-count billing, and how Medicaid plans in your state handle pregnancy-related services. We work inside your existing EHR, aim to submit most clean claims within 24 hours of final review. Claims are reviewed against applicable billing, coding and payer-specific rules before submission to help catch preventable errors.
Common codes we work with in OB/GYN
| Code | Description |
|---|---|
| 59400 | Routine obstetric care including antepartum care, vaginal delivery and postpartum care |
| 59510 | Routine obstetric care including antepartum care, cesarean delivery and postpartum care |
| 59426 | Antepartum care only, 7 or more visits |
| 59430 | Postpartum care only |
| 76805 | Obstetric ultrasound after first trimester, single or first gestation |
| 76817 | Transvaginal obstetric ultrasound |
| 58300 | Insertion of intrauterine device (IUD) |
| 57454 | Colposcopy of the cervix with biopsy and endocervical curettage |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where OB/GYN practices lose revenue
Global maternity packages and split care
Codes 59400 (vaginal delivery), 59510 (cesarean) and 59610 (VBAC) include routine antepartum visits, delivery and postpartum care. When a patient switches payers or providers mid-pregnancy, you bill antepartum care separately with 59425 (4 to 6 visits) or 59426 (7 or more visits), then the delivery-only and postpartum codes. Billing the full global after a transfer is one of the most common OB denials.
Separately billable prenatal services
Visits for problems outside routine prenatal care, such as gestational diabetes management or preterm labor evaluation, can be billed as E/M services with the right diagnosis linkage. Obstetric ultrasounds like 76801, 76805 and 76817 are also billed outside the global. Missing these leaves real money in the chart.
Preventive versus problem visits
Well-woman exams use preventive codes 99384 to 99397 for commercial plans, while Medicare uses G0101 for the pelvic and breast exam and Q0091 for Pap specimen collection. If a significant problem is addressed at the same visit, a problem-oriented E/M with modifier 25 can be added when documentation supports it.
Contraception and in-office procedures
IUD insertion (58300) and implant insertion (11981) are billed with the device HCPCS code, and many plans cover them at no cost share under ACA preventive rules. Payers differ on whether they want the device billed by the practice or supplied through a specialty pharmacy, so verification before the visit matters.
What else affects OB/GYN revenue
A/R challenges in OB/GYN
OB/GYN A/R has a built-in lag because global maternity codes (59400, 59510, 59610, 59618) are usually billed after delivery, so months of prenatal care sit unbilled. When that delivery claim denies for a coverage change or a missing prenatal visit count, the largest claim in the chart is also the oldest work. We track open pregnancies as their own A/R group and work delivery claims as soon as the documentation is final.
Credentialing considerations
Medicaid pays for a large share of U.S. births, so most OB/GYN groups need enrollment with the state Medicaid program and each Medicaid managed care plan in their area. Every delivering provider also needs hospital privileges for labor and delivery and active enrollment with the patient's plan. Certified nurse midwives enroll and bill under their own NPI, and Medicare pays CNM services at 100% of the physician fee schedule.
Payer considerations
Payers differ on whether they want one global claim, split antepartum, delivery and postpartum billing, or visit-by-visit prenatal claims. Most states have extended Medicaid postpartum coverage to 12 months, which changes how late postpartum visits are billed. Under ACA rules, non-grandfathered commercial plans cover well-woman visits and FDA-approved contraception without cost sharing, but grandfathered plans may not.
OB/GYN coding details that affect payment
ICD-10 considerations
Chapter 15 O codes are sequenced first on pregnancy-related claims, and each one needs a Z3A code for weeks of gestation. Routine prenatal visits use Z34 codes by trimester, while high-risk supervision uses O09 codes, such as O09.523 for supervision of a pregnancy in an elderly multigravida in the third trimester. Gestational diabetes is coded by its control method, with O24.410 for diet controlled and O24.414 for insulin controlled. Z33.1 (pregnant state, incidental) is used only when the visit is unrelated to the pregnancy, and gynecology claims rely on codes such as Z01.419 for a routine gynecological exam and Z30.430 for IUD insertion.
Modifiers to watch
| 33 | Used on commercial claims for ACA preventive services, such as contraception counseling or IUD insertion, so the plan applies no cost sharing. |
|---|---|
| FP | Required by many Medicaid programs on family planning services, which may be paid at a higher federal match. |
| TH | Used by some Medicaid programs to identify prenatal or postpartum services billed outside the global package. |
| 22 | Added to a delivery code when the documentation shows substantially greater work than usual, such as extensive adhesions at cesarean. |
| 25 | Placed on a problem E/M billed the same day as a colposcopy, endometrial biopsy or preventive visit when the problem work is documented separately. |
Global periods
Gynecologic surgeries such as laparoscopic hysterectomy (58571) carry 90-day globals, while colposcopy with biopsy (57454) and endometrial biopsy (58100) carry 0-day globals. Postoperative visits inside a 90-day global are reported with 99024 for tracking only.
Medicare considerations
Medicare covers the screening pelvic and breast exam and Pap collection every 24 months for most patients and every 12 months for those at high risk, and the claim needs a diagnosis that shows which applies. Screening mammography (77067) is covered every 12 months. Medicare covers pregnancy care only for the small number of beneficiaries under 65 who qualify through disability, so most OB revenue depends on Medicaid and commercial plans.
OB/GYN billing KPIs to track
- Unbilled days on open pregnancies. Global maternity billing delays revenue for months, so tracking open pregnancies shows how much care is waiting to be billed.
- Global maternity denial rate. Denials on delivery claims usually come from coverage changes or missed transfers, and they hit the largest claim in the chart.
- Separately billable prenatal service capture. Ultrasounds and problem visits outside routine care are often left in the global, which lowers revenue per pregnancy.
- Device payment versus acquisition cost. IUDs and implants are expensive, so comparing payment to cost by payer shows whether buy and bill is working.
OB/GYN billing audit checklist
- Confirm each delivery claim matches the payer's preferred global or split billing method.
- Check that pregnancies with a coverage change or transfer are billed with 59425 or 59426 and the correct delivery-only code.
- Verify every O code claim includes a Z3A weeks of gestation code.
- Review obstetric ultrasounds and problem visits for separate billing outside the global package.
- Confirm contraceptive device codes are billed with the insertion code and the correct preventive modifier.
- Check Medicare well-woman claims for G0101 and Q0091 frequency and the high-risk or low-risk diagnosis.
Related: OB/GYN coding · denial management · RCM · billing audit · OB/GYN billing in Texas · Epic billing · athenahealth billing · RCM resources
How SFA runs OB/GYN billing
We set up a pregnancy tracker in your workflow so prenatal visits, ultrasounds and insurance changes are logged from the first appointment.
We verify benefits at intake and again in the third trimester to confirm the payer that will receive the delivery claim.
After delivery we choose the correct global or split-care codes and target submission within 24 hours of receiving final documentation.
We follow up on open OB claims and appeal bundling denials where the documentation supports it.
The services that matter most for OB/GYN
Eligibility Verification & Prior Authorization
Verifying coverage at the first prenatal visit and again before delivery catches insurance changes that break the global package.
Learn moreMedical Coding
Correct choice between global, antepartum-only and delivery-only codes decides whether the largest claim in the pregnancy gets paid.
Learn moreDenial Management
Bundling denials on ultrasounds and problem visits during pregnancy are common and usually winnable with the right appeal.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
OB/GYN billing questions
When should a global OB claim be submitted?
Most commercial payers want the global code billed after delivery, with the delivery date as the date of service. Some Medicaid plans allow or require billing antepartum care in parts. We follow each payer's policy so you are not waiting longer than necessary.
What happens if a patient changes insurance during pregnancy?
The global package can no longer be billed to one payer. Antepartum visits are billed to the original payer with 59425 or 59426 based on visit count, and delivery and postpartum care go to the new payer.
Can we bill an E/M visit during pregnancy?
Yes, when the visit addresses a problem outside routine prenatal care, such as hypertension in pregnancy or a urinary tract infection. Documentation and diagnosis coding need to show why the visit was separate from routine care.
How do you bill a well-woman exam for Medicare patients?
Medicare does not cover the full preventive exam codes. It covers the screening pelvic and breast exam with G0101 and Pap specimen collection with Q0091 at set frequencies, and other parts of the visit may be the patient's responsibility.
Do you handle OB/GYN billing in our current EHR?
Yes. We work inside the system you already use, including athenahealth, eClinicalWorks, NextGen, Kareo/Tebra and others, so your team does not have to change software.
See what your OB/GYN billing is missing
Send us a few details and an RCM specialist who knows OB/GYN will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
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An RCM specialist typically replies within one business day.