OB/GYN medical billing is two different jobs sharing one schedule. The obstetric side is a global maternity package that pays once, months after the first visit, and only when every antepartum encounter, the delivery and the postpartum visit were tracked to the same group. The gynecologic side is ordinary fee-for-service: ultrasounds, contraceptive devices, colposcopies and surgeries, each with its own bundling and authorization rules. In 2027 the obstetric book changes shape.
The global package pays once, so tracking starts at the first visit
A global obstetric code such as 59400 for vaginal delivery or 59510 for cesarean covers the routine antepartum visits, the delivery and the postpartum visit as one service, billed after delivery. Every prenatal visit must be logged against the pregnancy from the first confirmed visit, so at delivery the biller can show the visit count, who saw the patient and whether the same group delivered.
The failure mode is quiet. Antepartum visits get posted as ordinary E/M visits, then the global code is billed at delivery, and the payer sees the same care twice. Or the visits are held correctly, the patient delivers elsewhere, and nobody bills the antepartum care because the delivery trigger never came. We keep an open obstetric ledger per patient and reconcile it monthly.
Split care: when the package breaks apart
Patients transfer in, move away, change insurance mid-pregnancy, or are delivered by a hospitalist group. Then the care is billed in pieces: four to six antepartum visits with 59425, seven or more with 59426, one to three as individual E/M encounters. Delivery alone is 59409 or 59514, delivery with postpartum care is 59410 or 59515, and postpartum care alone is 59430.
A payer change costs the most. The first insurer owes the antepartum visits under its coverage; the second owes the delivery and whatever followed. Billing the whole global to the second payer, which most systems do by default, gets the claim denied or recouped. We date-stamp the change, split the ledger there and bill each payer its portion.
The 2027 maternity code change and the pregnancies that straddle it
The CPT 2027 code set retires the global maternity codes and their components. From January 1, 2027, each prenatal visit is reported as an E/M encounter when it happens, labor management is 59080 through 59083 by day and complexity, delivery is its own code such as 59431 for vaginal or 59502 for a primary cesarean, and postpartum visits are E/M again.
That moves an obstetric practice from one payment at delivery to payment through the pregnancy. Every patient who conceives in 2026 and delivers in 2027 will have visits held under the old rules and a delivery under the new ones, and payers will not all convert on the same day. We are building the per-payer rule now: which plans keep a global convention under contract, which switch on the effective date, and how held 2026 visits are released.
Ultrasound, non-stress tests and the services the package does not include
The global package covers routine care, not everything in a pregnancy. Obstetric ultrasounds (76801 in the first trimester, 76805 after it, 76811 for the detailed fetal anatomic survey, 76815 for a limited study and 76816 for follow-up), non-stress tests (59025) and management of complications such as gestational diabetes or hypertension are separately billable when the documentation supports it. Office ultrasound is billed globally; when a hospital owns the equipment, the physician bills the read with modifier 26.
Two things go wrong. A complication visit is documented as a routine prenatal check and absorbed into the global instead of billed as an E/M with the complication diagnosis. Or 76811 is billed without the indication and anatomic elements that distinguish it from 76805, and the payer downgrades it. We review ultrasound reports against the code and flag problem-pregnancy visits when the note reads as routine.
Devices, sterilization consent and the authorization trail
On the gynecologic side, the recurring work is contraceptive devices. An IUD or implant is two claims in one: the insertion (58300 for an IUD, 11981 for an implant) and the device under its own J code. A plan that covers the insertion may route the device to the pharmacy benefit, require an NDC, or cover only certain brands.
Sterilization has a paperwork rule of its own. Medicaid pays for a tubal ligation (58600), laparoscopic occlusion (58670) or salpingectomy for sterilization (58661) only when the federal consent form was signed at least thirty days before surgery and is still valid, and the form travels with the claim, so we check the consent date at scheduling. Colposcopy with biopsy (57454), endometrial biopsy (58100), LEEP (57460 and 57461), hysteroscopy and the larger surgeries mostly carry a 90-day global and need prior authorization by the specific code scheduled, because a hysterectomy authorized as 58571 and performed as 58573 will deny.
Preventive billing: the well-woman visit that becomes a problem visit
An annual gynecologic exam is billed as a preventive visit (99385 through 99397 by age and patient status) or, for Medicare, as G0101 for the pelvic and breast exam plus Q0091 for obtaining the Pap specimen. When the same visit also addresses abnormal bleeding or a breast lump, a separate problem-oriented E/M with modifier 25 is appropriate, and the patient may owe a copay on it. Medicare adds frequency rules for G0101 and Q0091 that depend on risk status, so we check the screening history before submission.
Taking over OB/GYN billing with pregnancies in progress
The hardest part of switching billers in obstetrics is pregnancies already underway. Before the switch, we build the open obstetric ledger from your schedule and prior biller's notes and confirm each patient's coverage and expected delivery date. The two-to-four-week parallel run does double duty: we watch how the outgoing biller holds antepartum visits and correct the ledger before we own it. The first step is a free A/R review, which includes last year's deliveries that never produced a global claim. Terms are month to month after the initial period, under a signed BAA, with a named account manager.
Codes and Modifiers We Watch in OB/GYN
The codes that most often decide whether a ob/gyn claim pays.
| Code | What it is | What goes wrong |
|---|---|---|
| 59400 | Routine obstetric care with vaginal delivery, global | Billed after delivery. Antepartum visits already posted as E/M make it a duplicate or a recoupment. Retires with CPT 2027. |
| 59510 | Routine obstetric care with cesarean delivery, global | Same tracking problem, plus the wrong global when the patient attempted a VBAC (59618) and the history is undocumented. |
| 59425 / 59426 | Antepartum care only, four to six visits / seven or more visits | Used when care is split. The visit count must be provable from the record and the dates must fall under the payer billed. |
| 59409 / 59410 | Vaginal delivery only / vaginal delivery with postpartum care | For hospitalist or covering-group deliveries. Billed as 59400 by mistake when the group did not provide antepartum care. |
| 59080-59083 / 59431 / 59502 | CPT 2027 labor management by day and complexity / vaginal delivery / primary cesarean | Effective for deliveries on and after January 1, 2027, with antepartum and postpartum visits reported as E/M. Pregnancies that straddle the date need a payer-by-payer plan. |
| 76805 / 76811 | Complete obstetric ultrasound after the first trimester / detailed fetal anatomic survey | 76811 is downgraded or denied when the report lacks the additional anatomic elements and a supporting indication. |
| 59025 | Fetal non-stress test | Denied as included in the global when billed without a diagnosis supporting monitoring or without a documented interpretation. |
| 58300, J7298, J7300, J7307 | IUD insertion and device supply codes (levonorgestrel IUS, copper IUD, etonogestrel implant, inserted under 11981) | The device pays separately from the insertion and is where denials cluster: NDC required, brand not covered, or device routed to the pharmacy benefit. |
| 58600 / 58670 / 58661 | Tubal ligation / laparoscopic tubal occlusion / laparoscopic salpingectomy for sterilization | Medicaid pays only with the federal sterilization consent form, signed at least thirty days before surgery and still inside its validity window. |
| G0101 / Q0091 | Medicare screening pelvic and clinical breast exam / obtaining a Pap specimen | Frequency limited by risk status. Billed too early it denies and the balance falls to the patient without an ABN. |
Common OB/GYN Denials and How We Fix Them
- CO-97
Antepartum E/M visits or an obstetric ultrasound denied as included in the global package.
FixIf the visit was routine, the ledger is corrected and the line written off; if it was a documented complication, it is resubmitted with the complication diagnosis. Ultrasounds are resubmitted with the indication when the payer’s policy pays them separately.
- CO-18
The global code denies as a duplicate because antepartum visits were already paid as E/M encounters earlier in the pregnancy.
FixReconcile the ledger against remittance history, void or refund the visits that should have been held, or bill the delivery-only code if the payer will not accept the correction. Then fix the hold rule so the next pregnancy does not repeat it.
- CO-27
Global claim denied because the patient’s coverage with that payer ended before delivery.
FixSplit the care at the coverage change date. Antepartum visits go to the first payer as 59425 or 59426; delivery and postpartum care go to the second. Eligibility is re-verified each trimester to catch the change before delivery.
- CO-16
A Medicaid sterilization claim is returned for missing information because the signed consent form was not attached, was signed inside the thirty-day wait, or had expired.
FixAttach the completed form and resubmit when the dates qualify. When they do not, the claim is not payable by Medicaid, so the consent date is checked against the surgery date at scheduling.
- CO-197
Hysterectomy, laparoscopy or sling procedure denied for no authorization, or authorized under a different code than the one performed.
FixRequest retro-authorization where the payer allows it and appeal with the operative report where the code changed intraoperatively. Upstream, the authorization is requested by CPT code and tied to the surgical schedule.
| Bundling edits applied | NCCI procedure-to-procedure pairs and medically unlikely editsSource: CMS, National Correct Coding Initiative |
|---|---|
| Global maternity codes retiring | 59400, 59510, 59610 and 59618 are deleted in the CPT 2027 code set, effective January 1, 2027Source: American Medical Association, CPT 2027 |
OB/GYN Billing: Common Questions
The global package is split at the coverage change date. Antepartum visits under the first payer are billed with 59425 or 59426 by count, or as E/M visits if three or fewer; the second payer is billed for the delivery, any later visits and the postpartum care. Both claims carry dates so neither payer sees overlap.
Your practice bills the antepartum care with 59425 or 59426 and the postpartum visit with 59430 if you provide it. The hospitalist group bills the delivery-only code. Do not bill the full global for a patient your group did not deliver; the payer will catch it against the hospital claim.
The CPT 2027 code set deletes 59400, 59510, 59610, 59618 and the antepartum and postpartum component codes. From January 1, 2027, prenatal and postpartum visits are reported as E/M encounters when they happen, labor management is 59080 through 59083 by day and complexity, and delivery is its own code. Payers will adopt the change on their own timelines, so we track each one and plan for pregnancies that begin in 2026 and deliver in 2027.
It depends on the plan. Many pay the device under the medical benefit with the J code and NDC, some require the pharmacy benefit, and some cover only specific brands. We verify which applies before the device is ordered so you are not left holding a device you cannot bill.
We build the open obstetric ledger before the switch: every active pregnancy, its held antepartum visits, current coverage and expected delivery date. The parallel run confirms the ledger against what the outgoing biller holds, so no pregnancy reaches delivery with visits unaccounted for.