OB/GYN Medical Billingand Revenue Cycle Management

Most practices land here for one of these.

Section 3

How the global package actually pays, and where it leaks

One claim, billed at delivery, is supposed to cover the prenatal series, the birth, and about six weeks afterwards. It only works when one group, under one tax ID, did all of that under one payer. Bill it when any of those conditions is missing and you either get a denial or a silent reprice.

A VBAC sent as 59400 rarely rejects. It pays the vaginal global and nobody on the remittance tells you that you left the VBAC differential on the table.

Inside the bundle

Routine prenatal visits (the usual schedule is about thirteen), admission H and P, uncomplicated labor, the delivery itself, first- and second-degree repair, routine postpartum through roughly day 42. Those lines are not extra claims next to the global.

Outside the bundle

Obstetric ultrasound. Non-stress test and biophysical profile. Labs. Amniocentesis. A problem visit for something that is not the pregnancy, with modifier 25 and a non-obstetric diagnosis. Management of gestational diabetes, preeclampsia, or other complications.

Sending those during the prenatal months is correct coding. It is also the only reliable cash while you wait for delivery.

Bill the pieces you furnished. Section 6 is the two that wreck AR.

59425 on a seven-visit chart is a silent underpayment. 59426 on a five-visit chart is a cut.

Why your days in AR look worse than MGMA

The global posts nine months of work on one date. Days in AR stretch because recognition is late, not because the front desk is slow. A growing obstetric panel can be fully booked and still short of cash. Generic AR targets were not built for this pattern. If a payer offers instalments after a set week, use them.

Section 4 — free OB/GYN coding tool

Global obstetric package checker

Answer eight questions about the pregnancy and delivery. It returns whether to bill the global or unbundle, the component codes, and why. There is nowhere to type anything about a patient, by design.

This tool also lives at its own address: /tools/global-ob-package-checker/.

Section 5

What 1 January 2027 actually changes

The AMA deleted the maternity globals. Effective date is 1 January 2027. Seventeen codes go, twelve arrive, six are revised. There is no grace period. Claims systems are expected to reject the old numbers for dates of service on or after that day.

Prenatal and postpartum become ordinary evaluation and management visits, one encounter at a time. New labor-management codes sit in the 59080 to 59083 range. Replacement delivery codes exist; do not memorise pairings from a blog. Wait for the printed 2027 book.

Settled versus not

Settled: the four globals, the four delivery-only codes, 59425, 59426 and 59430 are gone.

Not settled: CMS, in proposed rule CMS-1848-P (July 2026), floated fifteen G-codes that would keep a global-style Medicare payment next to the new CPT set. ACOG asked CMS not to run two systems. Comments closed 14 September 2026. Final values are expected around November 2026. Commercial plans will not move in lockstep.

Documentation is the real work

Under the bundle, the visit had to occur. Under E/M, the visit has to support a level. Thin prenatal notes that were good enough as "she came in" will not support 99213-style work in January.

ACOG has told plans to start using E/M for prenatal visits by 1 September 2026, and to add modifier TH so the visit still reads as maternity care. 59425 and 59426 still exist in 2026. They do not exist in 2027.

Build the note habit in the second half of 2026 while the global still covers you. Waiting until January means you learn leveling on live claims.

Section 6

Transfers and mid-pregnancy plan changes

Unbundle. The sending group bills prenatal care by visit band. The delivering group bills delivery, and postpartum if they did it. A plan change sends prenatal work to the first payer and delivery to the second.

Transfer

Your prenatal visits: E/M for three or fewer, 59425 for four to six, 59426 for seven or more. Their delivery: the delivery-only code, plus 59430 if they also did postpartum and you did not.

If she arrives late and you then deliver and see her afterwards under one payer, the global can still be correct. Transfer is not an automatic unbundle. What your tax ID actually provided is.

She changed insurance at 28 weeks

Neither plan owes a global, because neither covered the whole episode. Eight prenatal visits before the switch is 59426 to plan one. Delivery (and remaining care) goes to plan two.

The denial you keep getting is often a global sent to whoever is active on the delivery date. That plan is right to refuse nine months it never covered.

What the appeal needs

Visit count and dates of service, by coverage period. Not the chart narrative. If you cannot produce that list quickly, the plan's position wins.

Section 7

Well-woman and a problem on the same day

Both can pay: preventive code plus problem E/M with 25 on the problem line. The note has to look like two visits stapled together, not one story with a complaint in the middle.

Cover one section with your hand. The other section should still be a complete service: its own history or exam or medical decision-making, and its own assessment and plan. Auditors read these all year.

Medicare does not pay 99381 to 99397. It pays its own annual-wellness G-codes. Q0091 is a Medicare and Medicaid pap-collection code. Plenty of commercial plans bundle it. Appealing that bundle is usually wasted time.

Section 8

When the device costs more than the check

Insertion is one line. The device is another, one unit, product-specific J-code. Buy-and-bill means you bought it. If the allowed amount is below invoice, you lose money on a paid claim.

This shows up constantly on Medicaid and on Mirena-class devices in coder forums. Workarounds that actually get used: pharmacy benefit so you never carry inventory, or a cost-plus deal with the plan.

J7302 has been dead since 2015. J7299 (Miudella) starts 1 January 2026; do not drop that device onto J7300. If the pharmacy supplied it, bill the J-code at zero rather than inventing a purchase you did not make. Medicare generally will not pay 58300 for contraception; GY is the honest modifier.

Work the margin by product and payer before you reorder a shelf. Negative margin is not a coding puzzle. You change supply route, renegotiate, or stop stocking that SKU for that plan.

Non-grandfathered commercial plans are still required to cover FDA-approved contraception without patient cost-share, device plus insertion and removal. That does not raise your allowed amount. It does mean a balance billed to the patient is usually a routing error. Litigation is active, so re-read the mandate before you treat it as fixed.

Section 9

Why the scan came back not medically necessary

Wrong diagnosis for that CPT, or 76811 billed as if it were a deluxe 76805.

A complete study needs its listed elements. A limited study is a different code. If you attempted a complete and could not see everything, keep the complete code and add 52. Do not downgrade to limited; that is a different exam.

76811 needs a documented high-risk reason the plan accepts: age, prior anomaly, abnormal screen, diabetes, suspected growth restriction, or the plan's own list. 76801 stops at 13 weeks 6 days. One complete scan per pregnancy is the usual frequency rule; the next one is follow-up or limited.

Own the machine and read it: bill global. Own only the interpretation: 26 plus a signed report. Billing 26 on your own equipment donates the technical half.

NST plus BPP on the same service is 76818. Do not stack 59025 and 76819 on top of it.

Section 10

Medicaid volume, and the ceiling on what billing can do

KFF, using CDC natality data: Medicaid paid for 1.5 million births in 2023, 41 percent of US births, and 47 percent of rural births. State shares run from about 18 percent (Utah) to about 64 percent (Louisiana).

What a biller can change

• Eligibility before the delivery month, because some states will not pay a global unless she stayed eligible.
• State rules on visit minimums, secondary-only globals, and Category II quality codes.
• Transfer math.
• Denials that were never touched.

What a biller cannot change

The fee schedule. Full, fast collection of a bad rate is still a bad rate.

Twelve-month postpartum Medicaid is now in almost every state. If your billing calendar still thinks postpartum ends at day 60, you are leaving a year of coverage unused.

Section 11

When you should keep billing in house

A gyn-heavy office, two commercial plans, a long-stay biller who already wins 25s and J-codes: stay put. Obstetrics, transfers, Medicaid manuals, and the 2027 note standard are what make a specialist shop worth the percentage.

Stay in house when obstetric volume is thin, the mix is simple, denials get worked, and one person is not the entire institutional memory.

Look again when deliveries are a real share of revenue, Medicaid is thick, split care is weekly, cover for that biller does not exist, or nobody has a 2027 documentation plan.

Three pulls

1. 1Last quarter's VBACs. How many went out as 59400?
2. 2Antepartum-only claims. Does the visit count match 59425 versus 59426?
3. 3One LARC SKU at your largest payer. Invoice versus allowed, plus insertion.

What we will not pretend to do

Raise Medicaid. Force a device payment above the allowed amount. Postpone January 2027. We will bill the global when it still applies, take it apart when it does not, and get prenatal notes ready while the bundle still hides thin documentation.

Section 12

What we handle

Section 13

Free 48-hour AR audit

We read the file and tell you whether the globals, visit bands and device margins are the problem. If the books are clean we say so.

Section 14

Common questions

Section 15

Sources

• AMA, CPT 2027 maternity care services code changes, 8 July 2026
• AMA, CPT code set, psychotherapy and maternity time rules
• ACOG, Payment for Obstetric Services; Payment Advocacy for Obstetric Services
• ACOG, statement on AMA release of new obstetric codes, April 2026
• CMS, CMS-1848-P, CY2027 PFS proposed rule
• CMS, CY2026 PFS final rule
• CMS, NCCI Policy Manual
• SMFM, Coding Tips for maternal-fetal medicine
• SMFM, Coding Questions and Answers
• KFF, Births Financed by Medicaid, 2023
• KFF, Births by Source of Payment for Delivery
• Georgetown CCF, postpartum coverage extension
• HRSA, Women's Preventive Services Guidelines