OB/GYN CPT Families Coded
Clean Claim Rate
Years in U.S. Medical Billing
OB/GYN practices without strong global maternity and split-care controls commonly lose 10 to 20% of revenue to incorrect bundling, missed complication billing, and mismatched split-care code combinations. Most of it traces back to a small number of recurring coding decisions, which is exactly where specialty-specific billing pays for itself.
Where OB/GYN billing actually goes wrong
OB/GYN billing, done right
The coding decisions that cause most OB/GYN denials, handled by billers who know the specialty, not just the CPT book.
Global Maternity Package Accuracy
Since CPT 59400 and 59510 bundle antepartum, delivery, and postpartum care into one payment, billing separate E/M codes alongside them without a valid exception causes an automatic denial. We verify that global billing conditions are genuinely met before submitting under a bundled code.
Split-Care Code Selection
When a patient transfers care mid-pregnancy or changes insurance, the correct billing combination depends on exactly which components each provider delivered. We select antepartum-only, delivery-only, or combined codes based on documented visit counts and care transitions, not guesswork.
Complication & Excluded Service Billing
Because conditions like hyperemesis gravidarum and pregnancy-related diabetes management fall outside the routine global package, they remain separately billable even during the maternity bundle. We identify and bill these excluded services so they don't get absorbed into the global payment for free.
Ultrasound & Diagnostic Reimbursement
Since only medically necessary ultrasounds beyond routine prenatal monitoring are separately reimbursable, distinguishing routine from diagnostic imaging determines whether the claim gets paid. We code diagnostic imaging correctly against payer-specific ultrasound limits.
Well-Woman & Gynecological Procedure Coding
Well-woman visit coding depends on patient age and new-versus-established status, while gynecological procedures like hysterectomy depend on surgical approach and uterine weight. We match each visit and procedure to the correct code based on these clinical variables.
2027 CPT Restructure Readiness
Since the AMA has already approved new obstetric codes replacing much of the current global structure starting January 2027, practices that don't prepare now risk billing disruptions later. We build workflows that transition smoothly when the new code set takes effect.
OB/GYN-specific, not generalist
Billers who know cath lab bundling rules
A biller who treats every specialty the same way will bundle a delivery-only case under the full global code and never understand why the payer denied it. Since OB/GYN revenue leaks rarely sit in one place, they instead spread across split-care code selection, excluded-service billing, and global package documentation that most billers never learn to separate correctly. Ultimately, treating OB/GYN billing like standard surgical or E/M billing is exactly where the revenue disappears.
Talk to a specialistCaught before submission
Fewer denials, faster reimbursement
OB/GYN practices without strong front-end controls commonly see first-pass denial rates of 12 to 20%, driven largely by incorrect global bundling, missed split-care scenarios, and under-billed complications during pregnancy. Because we catch these before the claim goes out rather than after the denial comes back, practices see cleaner claims from the first submission.
See how it works
What we hold ourselves to
Our values, in practice
Intake & Systems Review
We audit current global maternity billing patterns and split-care workflows.
Charge Capture & Coding
Pregnancy episodes get coded based on documented visit counts, care transitions, and delivery method.
Claims Scrubbing
Claims run through payer-specific and global maternity edits before submission.
Submission & Tracking
Clean claims go out daily, and every claim gets tracked to resolution.
Denial Management
Denials get corrected and resubmitted within payer timely-filing windows.
Complication & Excluded Service Monitoring
Pregnancy complications and non-routine services get flagged and billed separately from the global package.
Reporting
Monthly reports show clean claim rate, denial trends, and days in A/R by service type.
Questions, answered
OB/GYN billing, answered
What OB/GYN practices ask most before switching billing partners.
What makes OB/GYN billing different from other specialties?
OB/GYN billing centers on the global maternity package, which bundles months of antepartum care, delivery, and postpartum visits into a single payment rather than billing each visit separately. Because this structure requires precise tracking of what's included versus excluded, it demands a completely different coding approach than standard E/M or surgical billing./p>
When should a practice bill split-care codes instead of the global maternity package?
Split-care codes apply whenever a patient transfers to a different provider mid-pregnancy, changes insurance, or has a different physician handle the delivery than the one who provided antepartum care. In these cases, billing the standard global code instead of the correct component codes results in inaccurate reimbursement for the actual care each provider delivered.
Are pregnancy complications billed separately from the global maternity package?
Yes, conditions like hyperemesis gravidarum requiring management or pregnancy-related diabetes fall outside routine maternity care and remain separately billable even during the global period. Many practices under-bill these because they assume everything pregnancy-related is absorbed into the bundled payment.
Why do global maternity claims get denied even when the pregnancy was routine?
Payers increasingly audit the individual components beneath the bundled payment, so if documentation doesn't clearly support the required number of antepartum visits, delivery, and postpartum care under one provider, the claim can deny despite an uncomplicated pregnancy. Precise visit documentation throughout the pregnancy protects against this.
What is changing with OB/GYN billing in 2027?
The AMA CPT Editorial Panel has approved new obstetric codes set to replace much of the current global maternity structure starting January 2027, and ACOG recommends payers and practices begin transitioning by September 2026. Practices that don't prepare their billing workflows in advance risk disruptions once the new code set takes effect.
What denial rate should an OB/GYN practice expect?
A well-run OB/GYN billing operation should see a denial rate under 7%, with first-pass clean claims above 93%. Practices without strong global maternity and split-care controls commonly see denial rates well above that, since bundling errors account for a large share of preventable OB/GYN denials.
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