Specialty billing
OB-GYN Medical Billing Services
OB-GYN billing is unusual because obstetric care is billed as a global package spanning roughly nine months, covering antepartum visits, delivery and postpartum care in a single code. When a patient transfers, changes coverage or delivers unexpectedly, that global package must be unbundled correctly or revenue is lost.
OB-GYN benchmarks
- Typical denial rate
- 11–17%
- Days in AR
- 40–55
- Achievable clean claim rate
- 96%+
Typical ranges for OB-GYN practices. Your actual numbers are measured during the audit.
The complexity
Why ob-gyn is uniquely difficult to bill
Obstetric care bills as a global package spanning the pregnancy, not per visit
Patient transfers mid-pregnancy require the global package be split into itemized components
Coverage changes during pregnancy complicate which payer owns which portion of care
Delivery method determines the global code and cannot be known at package initiation
Preventive gynecologic visits and problem visits carry different coverage rules
Ultrasound codes vary by trimester, purpose and whether the study is complete or limited
Coding
OB-GYN procedure codes we work with daily
A representative sample, not an exhaustive list. Coders are assigned by specialty rather than pooled.
| Code | Description |
|---|---|
| 59400 | Routine obstetric care including antepartum, vaginal delivery and postpartum care |
| 59510 | Routine obstetric care including antepartum, cesarean delivery and postpartum care |
| 59425 | Antepartum care only, 4–6 visits |
| 76805 | Obstetric ultrasound, after first trimester, complete |
| 58558 | Hysteroscopy with sampling or polypectomy |
| 57454 | Colposcopy of cervix with biopsy and endocervical curettage |
Revenue leakage
Where ob-gyn practices lose money
These are the denial patterns specific to this specialty — the ones a general-purpose billing service will not be looking for.
Global package errors
Individual antepartum visits billed separately when the global obstetric code already includes them, or the reverse after a transfer.
Coverage changes mid-pregnancy
Global package billed to a payer that did not cover the full span of care, requiring itemization the practice never performed.
Preventive versus problem visits
Annual well-woman visits billed as problem visits, or a problem visit billed without modifier 25 alongside a preventive service.
Ultrasound frequency limits
Obstetric ultrasounds denied where the count exceeds the payer's covered frequency without documented medical indication.
Global surgical bundling
Post-operative gynecologic visits billed within the surgical global period without an appropriate modifier.
Payer landscape
What OB-GYN practices need to know about payers
Payer policy drives more ob-gyn denials than coding does. Knowing the policy before the service is what prevents them.
- Medicaid covers a substantial share of obstetric care nationally, and its global package rules differ by state program.
- When a patient's coverage changes mid-pregnancy, the global package must be split — most practices lose revenue here through inaction rather than error.
- Screening versus diagnostic distinction on Pap and HPV testing drives whether patient cost-sharing applies.
Questions
OB-GYN billing FAQ
Last updated August 20, 2026
Reviewed by a certified coding leadRoutine obstetric care is billed once, after delivery, using a global code covering antepartum visits, the delivery itself and postpartum care. The code depends on delivery method, which is why the claim is submitted after delivery rather than during pregnancy. Complications and unrelated problems are billed separately as they occur.
The global package no longer applies and care must be itemized — antepartum-only codes based on visit count, plus a delivery-only code for whoever performs the delivery. Practices commonly lose revenue by continuing to expect global payment for care they only partly provided, or by never billing the antepartum portion at all.
We track coverage continuously across the pregnancy rather than verifying once at intake. When coverage changes, the care span is split and billed to the correct payer for each portion. Catching the change during pregnancy is straightforward; discovering it after submitting a global claim is not.
Usually because a preventive visit and a problem-focused visit occurred together and were billed without modifier 25 distinguishing them, or because a preventive service was coded as problem-focused and lost its no-cost-sharing status. Both are documentation and coding issues rather than coverage issues.
Primary sources
Coverage, rates and local policy for ob-gyn, at the source.
- Global Surgery booklet (opens in a new tab)
Centers for Medicare & Medicaid Services — What the 10 and 90-day global periods include, and which modifiers break out of them. The authority behind most postoperative bundling disputes.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
- State Medicaid program overviews (opens in a new tab)
Medicaid.gov — Program structure, delivery model and waivers by state. Our state pages summarise the program name and delivery model; this is the authoritative source behind them.
Get a free ob-gyn billing audit
We'll review your ob-gyn denial patterns, coding accuracy and AR aging against the benchmarks above. Takes about two minutes to request.
No setup fees · You pay when we collect · Pricing from 3% of net collections