OB-GYN billing
OB-GYN billing services
We handle billing for OB-GYN practices, from global maternity packages and split-care deliveries to well-woman visits, ultrasounds and contraception. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Global OB packages and split-care billing tracked from first visit to postpartum
- Preventive plus problem-visit coding with modifier 25 done right
- LARC procedures billed with the device supply code and units
Why OB-GYN billing is different
Maternity care is billed over months, not visits
Most OB-GYN revenue depends on a nine-month episode that is billed once, plus a gynecology side that mixes preventive and problem care. Both have their own traps.
Global obstetric packages
Routine prenatal visits, the delivery and postpartum care are usually billed as one global code (such as 59400 or 59510) after delivery. If the prenatal visits are not tracked, the practice can lose the whole episode or bill it wrong.
Split care and insurance changes
When a patient transfers in or out, or changes insurance mid-pregnancy, the global package no longer applies. Antepartum-only, delivery-only and postpartum-only codes are used instead, and the visit count decides which antepartum code fits.
Preventive and problem visits together
A well-woman exam and a separate problem addressed the same day can both be billed, with modifier 25 on the problem E/M. Payers look for documentation that shows the second service was significant and separate.
Pregnancy diagnosis coding
Pregnancy codes in ICD-10-CM carry the trimester, and a weeks-of-gestation code (Z3A) is usually added. Mismatched trimesters or missing gestation codes are common reasons for rejection.
Contraception and devices
IUD and implant procedures are billed with a procedure code plus a HCPCS supply code for the device. Coverage under preventive benefits, units and modifier 33 rules differ by payer.
OB ultrasound limits
Many payers cap routine obstetric ultrasounds per pregnancy and require a supporting diagnosis for extra scans. In some settings the professional and technical components are billed separately.
Common codes
OB-GYN codes we review before every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 59400 / 59510 / 59610 | Global maternity care with vaginal delivery, cesarean delivery or VBAC | Same practice provided prenatal, delivery and postpartum care; billed after delivery |
| 59425 / 59426 | Antepartum care only (4 to 6 visits / 7 or more visits) | Patient transferred or changed insurance; visit count documented |
| 59409 / 59410 / 59430 | Delivery only, delivery with postpartum care, postpartum care only | Used when care is split between practices or payers |
| 99384–99387 / 99394–99397 | Preventive visits by age, new and established patients | Modifier 25 on a same-day problem E/M; preventive benefit limits |
| G0101 / Q0091 | Medicare pelvic and breast exam; screening Pap collection | Medicare frequency rules; not interchangeable with commercial preventive codes |
| 76801 / 76805 / 76815 / 76817 | Obstetric ultrasounds (first trimester, after first trimester, limited, transvaginal) | Per-pregnancy limits, supporting diagnosis, 26/TC where split |
| 58300 / 11981 + J7296–J7301 / J7307 | IUD or implant insertion plus the device supply | Correct device code and units; preventive coverage and modifier 33 by payer |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
The OB-GYN denials we stop before they happen
Most OB-GYN denials come from timing and eligibility, not from the care itself. We catch them at charge entry.
- Global package billed when the patient changed payers or practices mid-pregnancy
- Prenatal visits billed one by one when they belong inside the global code, or the reverse
- Missing or mismatched trimester and weeks-of-gestation diagnosis codes
- Problem visit denied with a preventive exam because modifier 25 or documentation was missing
- IUD or implant claims missing the device code, NDC or correct units
- Extra OB ultrasounds billed without a diagnosis that supports medical necessity
- Newborn or delivery claims held because eligibility or Medicaid pregnancy coverage was not confirmed
What we handle
Everything between the visit and the payment
Our core focus is behavioral health. We bill OB-GYN practices with the same team, the same process and the same promises.
- Insurance eligibility and benefits checks before visits, including pregnancy coverage
- Charge entry and coding review of global OB, preventive, E/M and procedure codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for every provider
- Patient statements and balance tracking (patient calls go to your office or an optional RevenueCTRL virtual assistant)
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for OB-GYN practices
Billing starts at 2.5% of collections, or a flat monthly fee. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing. No setup fee and no long-term contract.
Common questions
When do you bill the global OB package?
We bill it after delivery, once the practice has provided the prenatal care, delivery and postpartum care. Until then we track each prenatal visit so the package is complete and supported. Some payers, especially Medicaid plans, have their own rules, and we follow them.
What happens if a patient changes insurance during pregnancy?
We split the care into separate claims. Prenatal visits under the old plan are billed with an antepartum-only code, and the delivery and postpartum care are billed to the new plan. We check eligibility at each visit so the change is caught early.
Can we bill a problem visit on the same day as an annual exam?
Yes, when a significant, separate problem is addressed and documented. The preventive code is billed along with a problem E/M that carries modifier 25. Some payers still apply cost sharing to the problem visit, so we make sure your front desk knows.
Do you bill the IUD or implant device separately?
Yes. The insertion is billed with a procedure code such as 58300 or 11981, and the device is billed with its own HCPCS supply code. We check the device code, units and each payer’s preventive coverage rules before submission.
Do you credential certified nurse-midwives and nurse practitioners?
Yes. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing. Medicare and Medicaid enrollments are priced separately.
Which EHRs do you work in?
We work in athenahealth, AdvancedMD, eClinicalWorks, Tebra (Kareo), DrChrono, Office Ally and others. We use the system you already have.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
Prefer to talk? +1 770-520-0840
Thank you. We have your request.
A billing specialist will reply within 1 business hour during business hours (Mon–Fri, 9am–6pm ET). Want to pick a time now?
Book a call on Calendly