OB/GYN billing services built around the maternity episode
OB/GYN billing services have to follow a pregnancy for most of a year before the largest claim goes out. Patients switch employers, qualify for pregnancy Medicaid or cross into a new plan year with a fresh deductible, and each change affects who pays for delivery. Gynecology adds preventive visits, office procedures and surgery, each with its own rules.
Fastora handles OB/GYN medical billing inside your existing EHR, with certified billers and coders reviewing each claim. The work sits on top of our core medical billing services: eligibility, coding, claim submission, payment posting and follow-up.
Maternity eligibility and benefit checks
We verify coverage at the first prenatal visit and record the maternity benefit: whether delivery is covered in network, the deductible and coinsurance that apply, and whether the plan has a separate inpatient or global maternity cost share. Patients receive an estimate of their share early, while there is time to plan.
Eligibility is re-checked at the start of the third trimester and again before delivery. If a patient has moved to a new plan, the antepartum care already given belongs to the old payer and the delivery to the new one, so the episode is split rather than billed globally. Our eligibility and benefits verification team flags these changes as they happen.
Authorization for obstetric ultrasounds and gynecologic surgery
Some plans limit routine obstetric ultrasounds and require authorization for additional or detailed studies, such as a detailed fetal anatomic examination. Hysterectomy and other gynecologic surgeries commonly need approval with documented conservative treatment. Approvals are tied to the planned procedure code and facility, so a change in approach or location needs an update before the claim is billed.
Codes and rules specific to OB/GYN coding
OB/GYN coding centers on the obstetric package codes. The global codes bundle routine antepartum visits, the delivery and routine postpartum care into one service, billed once after delivery.
| Code | Descriptor (summary) |
|---|---|
| 59400 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care |
| 59510 | Routine obstetric care including antepartum care, cesarean delivery and postpartum care |
| 59610 / 59618 | Routine obstetric care with vaginal delivery after previous cesarean / with cesarean delivery following attempted vaginal delivery after previous cesarean |
| 59409 / 59410 | Vaginal delivery only / vaginal delivery including postpartum care |
| 59514 / 59515 | Cesarean delivery only / cesarean delivery including postpartum care |
| 59425 / 59426 | Antepartum care only: 4–6 visits / 7 or more visits |
| 59430 | Postpartum care only |
| Z3A.- | ICD-10-CM category reporting weeks of gestation on obstetric claims |
Global OB billing versus split billing
Global OB billing works only when one practice provides all three parts of the episode under one payer. When a patient transfers care, changes insurance or delivers elsewhere, the episode is split. If only one to three antepartum visits took place, many payers expect them to be billed as individual E/M visits rather than with 59425 or 59426. Check each payer's maternity policy, because some require the first prenatal visit date on the global claim.
Services outside the package
Obstetric ultrasounds, lab tests and visits for a complication such as gestational diabetes or hypertension are generally billed separately when the diagnosis and documentation support them. Gynecologic procedures follow the surgical global periods, so post-operative visits inside the global period are not billed. Well-woman visits with a new problem need the preventive code plus a separately documented problem visit with modifier 25; see our guide to modifier 25.
Obstetrics billing documentation
Obstetrics billing depends on records that hold up across months of care. We look for the following before a global claim is released:
- Date of the first antepartum visit and the total number of antepartum visits
- Delivery date, method and delivering provider
- Weeks of gestation recorded so the Z3A code matches the delivery note
- Separate notes for complication visits, with the diagnosis that supports billing them outside the package
- Postpartum visit date, or a note that postpartum care moved to another provider
Common denials and how we prevent them
Global maternity claims are held until delivery, so the timely filing clock and the first-visit date both need watching. Most OB/GYN denials trace back to a few patterns, and each is fixed at the source rather than only on the claim.
| Denial pattern | Prevention step |
|---|---|
| Global code billed after an insurance change | Re-check eligibility in the third trimester and split the episode by payer |
| Antepartum visits billed both individually and in the package | Hold prenatal E/M charges that belong to the package until delivery |
| Missing or mismatched weeks-of-gestation code | Compare the Z3A code with the delivery record during claim review |
| Preventive visit denied or moved to problem cost share | Code the preventive and problem services separately with modifier 25 where supported |
| Ultrasound or surgery without authorization | Match the approval to the performed code and facility before billing |
Denied claims are worked through our denial management workflow with the antepartum record attached. A single global claim carries most of a pregnancy's revenue, so these claims get close follow-up, and maternity deductibles are set up on patient payment plans early.
Credentialing for OB/GYN practices
New obstetricians, nurse practitioners and certified nurse midwives need to be enrolled with each payer before they deliver or see patients, and hospital privileges for delivery are a separate process the practice manages with each facility. Fastora tracks payer enrollment through a nine-stage process, from document collection and CAQH setup to panel submissions and the effective date. Texas practices that see pregnant Medicaid patients also need Texas Medicaid enrollment and contracts with the relevant managed care plans; see our Texas Medicaid billing guide.
How Fastora supports OB/GYN medical billing
Each practice has a dedicated account contact, a transparent dashboard and a monthly review call covering held maternity claims, denials and AR by payer. We sign a Business Associate Agreement before accessing PHI and work under the user access your practice grants. A free billing assessment reviews a sample of your global and gynecology claims before you commit to anything, and pricing is quoted after that review.
OB/GYN billing and coding: the global period done right
OB GYN medical billing lives and dies on the global obstetrical package: routine antepartum visits, the delivery and postpartum care billed as one code, with everything outside it billed separately. Our obgyn billing services track the global period per patient so a separately billable ultrasound or complication visit is never folded into the package by mistake. The gynecology side has its own traps — gyn billing and coding around annual exams with problem-oriented work, colposcopy and LEEP — where the right modifiers decide whether the claim pays or denies as bundled.
Practices comparing a gyn billing company should ask about global-period tracking specifically — it is the single biggest source of lost OB revenue, and it is invisible on a standard A/R report. See our medical billing services for the full cycle.
VOB, COB and EOB posting for OB/GYN claims
Front-end work matters here: VOB services confirm the maternity benefits and deductible status before the first antepartum visit, so the practice knows what to collect and when. And COB in medical billing — coordination of benefits — comes up often with dual-covered maternity patients: the claim has to go to the primary payer first or it denies. On the back end, our EOB posting services reconcile every OB payment against the expected global fee, so underpayments surface instead of hiding inside a paid claim. Related services: payment posting service and eligibility verification.