OB/GYN Billing Guide 2026
Global OB Package, Delivery Codes, and Maternity Billing
Obstetric and gynecologic billing is among the most complex in outpatient medicine. The global OB package bundles dozens of services into a single code, but knowing when to unbundle, which modifier to append, and how to handle high-risk pregnancies and cesarean deliveries requires deep specialty knowledge. This guide covers every critical billing rule for OB/GYN practices in 2026.
1. Understanding the Global OB Package
The global obstetric package is a bundled payment covering the full scope of maternity care from the first antepartum visit through the postpartum visit. Payers reimburse a single global code rather than individual visits, unless specific criteria allow unbundling.
| CPT Code | Service | Includes |
|---|---|---|
| 59400 | Vaginal delivery, global | Antepartum care, vaginal delivery, postpartum care |
| 59510 | Cesarean delivery, global | Antepartum care, cesarean delivery, postpartum care |
| 59610 | VBAC, global | Antepartum care, vaginal delivery after prior C-section, postpartum |
| 59618 | VBAC attempt → cesarean, global | All antepartum, attempted vaginal delivery, cesarean, postpartum |
What the global package includes: The antepartum component covers the initial OB history and physical, plus all subsequent antepartum visits, typically defined as the first visit plus up to 12 additional antepartum visits. The delivery component covers the delivery itself. The postpartum component covers a single postpartum office visit.
What it does NOT include: Lab work, ultrasounds, non-stress tests, amniocentesis, fetal monitoring, high-risk consultations, and complications requiring additional E/M visits are all separately billable. Understanding this distinction is where most OB billing revenue is either captured or lost. The dollars add up quickly: even a modest error rate here means avoidable revenue loss every year.
2. Antepartum-Only and Delivery-Only Codes
When a physician provides only part of the obstetric care, for example, because the patient transfers providers mid-pregnancy, or because the delivering physician is a different provider; you bill the component codes, not the global package.
| CPT Code | Service | When to Use |
|---|---|---|
| 59425 | Antepartum care only, 4–6 visits | Physician provides 4–6 antepartum visits, no delivery |
| 59426 | Antepartum care only, 7+ visits | Physician provides 7 or more antepartum visits, no delivery |
| 59409 | Vaginal delivery only | Delivering physician did not provide antepartum or postpartum care |
| 59410 | Vaginal delivery including postpartum care | Delivering physician also provided the postpartum care, but not the antepartum care |
| 59514 | Cesarean delivery only | Delivering physician did not provide antepartum or postpartum care |
| 59515 | Cesarean delivery including postpartum care | Delivering physician also provided the postpartum care, but not the antepartum care |
| 59430 | Postpartum care only | Postpartum care provided by a different physician |
OB Delivery Codes and 2026 Medicare Rates
Use 59409 for a vaginal delivery only and 59514 for a cesarean delivery only when the physician didn't provide the antepartum care. 59410 and 59515 are different: they include postpartum care. Report the global codes 59400 and 59510 only when you provided the whole package.
At 2026 Medicare national rates, 59400 (vaginal delivery with antepartum and postpartum care) pays $2,214.48 and 59510 (cesarean) pays $2,473.34. Delivery-only 59409 pays $721.79 and 59514 pays $823.67. Those are national figures, so locality adjusts them, and commercial payers set their own rates and don't always follow Medicare's package rules.
| CPT | What it reports | 2026 Medicare rate (national) |
|---|---|---|
| 59400 | Vaginal delivery, global (antepartum, delivery, postpartum) | $2,214.48 |
| 59409 | Vaginal delivery only | $721.79 |
| 59410 | Vaginal delivery including postpartum care | $976.31 |
| 59510 | Cesarean, global | $2,473.34 |
| 59514 | Cesarean delivery only | $823.67 |
| 59515 | Cesarean delivery including postpartum care | $1,224.81 |
| 59425 | Antepartum care only, 4 to 6 visits | $574.83 |
| 59426 | Antepartum care only, 7 or more visits | $1,055.47 |
| 59430 | Postpartum care only | $261.20 |
3. High-Risk Obstetrics and Separately Billable Services
High-risk pregnancy management frequently involves services that are explicitly outside the global OB package and must be billed separately:
Ultrasound Billing
Ultrasounds are never included in the global OB package. Bill each separately:
- 76801: Obstetrical ultrasound, first trimester (single or first gestation)
- 76805: Obstetrical ultrasound, second or third trimester (standard)
- 76811: Detailed fetal anatomic survey (level II ultrasound)
- 76816: Follow-up ultrasound (subsequent to 76805/76811)
- 76817: Transvaginal ultrasound (obstetrical)
Fetal Monitoring and Testing
- 59025: Non-stress test (NST): separately billable, not part of global package
- 59020: Fetal contraction stress test
- 76818/76819: Fetal biophysical profile with/without NST
High-Risk Consultation and Management Codes
If a patient requires significantly more work than a typical pregnancy (due to diabetes, hypertension, multiple gestation, preterm labor risk, or other complications) modifier 22 may apply to the global delivery code.
- Modifier 22: Increased procedural services. Requires documentation that the work performed was substantially greater than typically required. Most payers require a written request letter with the claim explaining the additional complexity.
- Multiple gestation: Check the current CPT guidelines and your payer's policy for how to report each additional fetus before you bill. 59409 is a delivery-only code, not an add-on.
4. Gynecology Procedure Coding
Non-obstetric gynecology procedures are billed on a fee-for-service basis with no global package bundling. The most commonly miscoded GYN procedures:
| CPT Code | Procedure | Key Billing Rule |
|---|---|---|
| 57454 | Colposcopy with biopsy and ECC | Don't bill 57455 (biopsy only) and 57456 (ECC only) together; 57454 is the correct combined code |
| 58300 | IUD insertion | Bill the device separately with its J-code: J7298 (Mirena), J7297 (Liletta), J7301 (Skyla) or J7296 (Kyleena). Medicare lists 58300 as non-covered, so verify the benefit first |
| 58301 | IUD removal | If removed and replaced in the same session, report both 58300 and 58301 with modifier 51 or 59 on the lower-paying service (payer rules vary) and use Z30.433 |
| 58558 | Hysteroscopy with biopsy | Global period: 0 days. Don't bill office visit same day without modifier 25 |
| 57522 | LEEP conization of the cervix | Global period: 90 days. Includes related E/M within global period. 57460 (LEEP biopsy) has a 0-day global |
| 58661 | Laparoscopic salpingectomy | If bilateral, append modifier 50 or bill two units per payer policy |
Annual Well-Woman Exam Billing
The preventive well-woman exam is billed based on patient age and payer type. Use the appropriate preventive E/M code:
- 99384–99387: New patient preventive E/M by age range
- 99394–99397: Established patient preventive E/M by age range
- G0101: Cervical/vaginal cancer screening (pelvic exam + clinical breast exam for Medicare patients)
- Q0091: Obtaining cervical/vaginal smear (Pap smear collection)
When a problem is identified and addressed during the well-woman exam, append modifier 25 to the medically necessary E/M code to bill both preventive and problem-oriented services on the same day.
5. Common OB/GYN Denial Reasons and Prevention
| Denial Reason | Root Cause | Prevention |
|---|---|---|
| Global package billed when only partial care provided | 59400 billed when patient transferred or different MD delivered | Track care transfers in EHR; default to component codes when in doubt |
| Ultrasound denied as part of global | Payer incorrectly bundles 76805 into 59400 | Bill on separate claim or separate date; document medical necessity |
| Modifier 22 denied | Missing supporting documentation | Always submit cover letter detailing complexity with Mod 22 claim |
| IUD device not covered | J-code submitted without coverage verification | Verify IUD benefit before insertion; many plans require PA for certain devices |
| Same-day procedure + E/M denied | Missing modifier 25 on E/M when performed same day as minor procedure | Add modifier 25 to E/M code when a separately identifiable service was performed |
| Delivery code mismatch | 59400 billed but chart documents cesarean | Delivery code selection must match operative report and delivery documentation |
6. Postpartum and Newborn Billing
Postpartum care within the global OB package covers a single postpartum office visit. Any additional postpartum visits for complications are separately billable using standard E/M codes. Important distinctions:
- Postpartum depression screening (96127): Report 96127 per standardized instrument (Medicare pays $5.01). G8431 and G8510 are MIPS quality codes, not postpartum codes. Coverage depends on the payer
- Newborn circumcision (54150): Billed by the delivering physician or pediatrician; includes local anesthesia
- Hospital E/M for newborn (99460/99461): Billed by the physician managing the newborn, not the delivering OB physician, unless the OB is also the attending for the newborn
OB/GYN Audit Exposure: Global Package Integrity and Ultrasound Billing
OB/GYN reviews check whether the global package was billed only when the practice actually provided the full scope of care. A patient who transferred mid-pregnancy or delivered with a different physician isn't a global package, and reviewers compare claims against the visit history in the record. A global code billed with a partial history is an overpayment. The repayment math is unforgiving: a 3-year lookback on a recurring documentation gap here can grow into a sizable repayment demand, plus the cost of defending the appeal.
Ultrasound billing is the second area. Ultrasounds fall outside the global package, so each must be medically necessary, ordered, documented with images and a report, and billed separately. Contractors can review three years of claims, and because obstetric claims repeat the same pattern for every patient, tracking care transfers in the EHR is the single best defense.
Frequently Asked Questions About OB/GYN
What CPT code is used for delivery only?
Use 59409 for a vaginal delivery only and 59514 for a cesarean delivery only when the physician didn't provide the antepartum care. 59410 and 59515 are different: they include postpartum care. Report the global codes 59400 and 59510 only when you provided the whole package.
How much does Medicare pay for the global OB package?
At 2026 Medicare national rates, 59400 (vaginal delivery with antepartum and postpartum care) pays $2,214.48 and 59510 (cesarean) pays $2,473.34. Delivery-only 59409 pays $721.79 and 59514 pays $823.67. Those are national figures, so locality adjusts them, and commercial payers set their own rates and don't always follow Medicare's package rules.
How do you bill an IUD removal and replacement on the same day?
Report 58300 for the insertion and 58301 for the removal, with modifier 51 or 59 on the lower-paying service depending on the payer's rule, and bill the device with its J-code, such as J7298 for Mirena. Z30.433 is the usual diagnosis. Check each payer's modifier preference first.
What does the global OB package include?
The article describes it as a bundled payment for the full scope of maternity care, from the first antepartum visit through the postpartum visit. Payers reimburse one global code unless the practice provides only part of the care.
When do you bill component codes instead of the global code?
When the physician provides only part of the care, for example because the patient transfers providers mid-pregnancy or a different physician delivers. You bill the antepartum, delivery, or postpartum component codes instead.
Are ultrasounds included in the global OB package?
No. The article says ultrasounds are never included and are billed separately, and high-risk pregnancy management also involves other separately billable services.