OB/GYN medical billing services
A global package that spans nine months and one claim, split billing when a patient transfers, and device revenue that is separate from the procedure that placed it.
Also called: Obstetrics · Gynecology · Women’s Health. We keep one page per specialty rather than a page per name.
Why OB/GYN billing is different
Obstetric billing is unlike anything else in outpatient medicine because the unit of billing is a pregnancy, not a visit. The global package covers routine antepartum care, delivery and postpartum care under a single code, submitted after delivery. Everything routine inside that span is included; everything outside it is separately billable. Practices lose money at both edges — billing routine visits that are included, and failing to bill problem visits, non-obstetric care and complications that are not.
Split billing is where it gets harder. Patients move, change insurance mid-pregnancy, or transfer practices. When that happens the global package no longer applies and the care has to be billed as antepartum-only codes by visit count, delivery-only, or postpartum-only. Getting that structure wrong on a transferred patient is one of the most common large-dollar losses in the specialty.
Ultrasound adds a component problem on top. Obstetric ultrasound is coded by trimester, by fetus count and by whether it is a limited or detailed study, and the professional and technical split depends on who owns the machine. Gynaecology brings its own layer: LARC devices are billed as a product separately from the insertion procedure, and the device code is frequently missed entirely.
Codes we work with
The families this specialty actually bills, and where each one carries a rule worth knowing.
| Family | Range | Notes |
|---|---|---|
| Global obstetric packages | 59400, 59510, 59610, 59618 | Vaginal, caesarean, VBAC and attempted VBAC |
| Antepartum care only | 59425, 59426 | Four to six visits, and seven or more |
| Delivery only and delivery with postpartum | 59409, 59410, 59514, 59515 | Used when the global package does not apply |
| Postpartum care only | 59430 | Where another practice delivered |
| Obstetric ultrasound | 76801–76817 | By trimester, fetus count, and limited or detailed |
| Gynaecologic ultrasound | 76830, 76831, 76856, 76857 | Transvaginal, saline infusion and pelvic |
| Office procedures | 57452–57461, 58100, 58110 | Colposcopy, endometrial biopsy |
| LARC insertion and removal | 11976, 11981–11983, 58300, 58301 | Procedure only — the device is billed separately |
| LARC devices | J7296–J7307 | Product codes, required for the practice to be paid for the device |
| Preventive and problem E/M | 99202–99215, 99381–99397 | Modifier 25 where both occur on one date |
Modifiers that matter
And the specific way each one is most often misused in this specialty.
| Modifier | Use | Common error |
|---|---|---|
| 25 | Separate E/M on the same day as a procedure | Omitted when a problem visit accompanies a preventive exam or a procedure |
| 59 / XU | Distinct procedural service | Missing on separate procedures performed in one session |
| 26 / TC | Ultrasound component split | Billed globally where the practice does not own the equipment |
| 22 | Increased procedural service | Claimed without the operative documentation that supports it |
| 51 | Multiple procedures | Applied to add-on codes exempt from the reduction |
| 80 / 82 / AS | Assistant at surgery | Not billed at all, or billed without the required qualifier |
Top denial reasons
With the CARC code you will see on the remittance, and what we do to stop each one recurring.
| Denial | CARC | How we prevent it |
|---|---|---|
| Service included in the global obstetric package | CO-97, CO-B15 | Global span tracked per pregnancy, with in-package visits recorded not billed |
| Component of the global package billed separately | CO-18 | Split-billing structure applied only where the global genuinely does not apply |
| Ultrasound not supported by the diagnosis | CO-50 | Indication mapped to payer policy, with fetus count and trimester documented |
| Provider not enrolled with the plan | CO-B7 | Credentialing status confirmed before the patient enters the global span |
| Device or drug code missing | CO-16, CO-4 | Device J-code billed alongside every insertion procedure |
Prior authorisation in this specialty
Obstetric care itself is rarely authorised, but nearly everything around it is: detailed anatomy and follow-up ultrasounds beyond a plan’s allowance, non-invasive prenatal screening, genetic testing, infertility services, and most gynaecologic surgery. Notification of pregnancy is also required by many plans within a set window, and missing it can affect how the global claim is adjudicated at the end. We handle the notification, the imaging authorisations and the surgical authorisations as a single tracked workflow across the pregnancy rather than as isolated requests.
Where revenue leaks
- Transferred patients billed under a global package that no longer applies, or not billed at all
- LARC device J-codes never submitted, so the practice absorbs the cost of the device
- Problem visits during pregnancy written off as included when they are separately billable
- Ultrasounds billed globally when only the professional component is payable
What we do for OB/GYN practices
The parts of the cycle where this specialty gains the most, framed for how it actually bills.
Provider Credentialing & Payer Enrollment
Payer enrollment, CAQH management, re-attestation, and contract negotiation.
See provider credentialingMedical Coding
Certified CPC and CCS coders assign and validate ICD-10, CPT, and HCPCS codes from your documentation.
See medical codingPrior Authorization Services
Auth requests submitted, tracked, and escalated so procedures aren't delayed.
See prior authorizationDenial Management & Appeals
Root-cause analysis, corrected claims, and clinical appeals filed inside payer deadlines.
See denial managementSee what this specialty is losing in your practice
We run the analysis against OB/GYN benchmarks, not a generic template. Send 90 days of claims data and keep the report either way.
Questions about OB/GYN billing
How do you handle a patient who transfers mid-pregnancy?
The global package no longer applies, so care is billed as antepartum-only by visit count, delivery-only or postpartum-only, as appropriate.
Do you bill LARC devices separately?
Yes. The device J-code is billed alongside the insertion procedure — missing it means the practice absorbs the device cost.
Are problem visits during pregnancy billable?
Conditions unrelated to the pregnancy, and complications outside routine antepartum care, are separately billable. Routine visits inside the global span are not.
Do you handle notification of pregnancy?
Yes, within each plan’s required window, alongside the imaging and surgical authorisations across the pregnancy.
Adjacent specialties
Specialties whose billing shares rules, payers or authorisation patterns with this one.