OB/GYN Billing Guide 2026: Global OB Package, Delivery Codes, and Maternity Billing

By RCMAXIS Coding Team  ·  June 2026  ·  14 min read

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.

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.

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.

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. Expect a 15–30% reimbursement increase when justified.
• Multiple gestation: Bill additional unit for each additional fetus delivered (add-on code 59409 for each additional vaginal delivery).

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:

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

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 (G8431/G8510): Separately reportable quality measures; may be billable depending on payer and contract
• 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