OB/GYN Billing Cheat Sheet (2026)
Almost every OB/GYN billing error traces back to the global obstetric package, specifically what it includes and what it does not. Bill inside the global and you lose visits you could have captured. Bill outside it without the documentation and the claim is denied.
Quick reference for ob/gyn billers. Last updated .
Top OB/GYN CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 59400 | Routine obstetric care (vaginal delivery, global) | $2,214.48 | $2,214.48 | 66.30 |
| 59510 | Cesarean delivery (global) | $2,473.34 | $2,473.34 | 74.05 |
| 59610 | VBAC (vaginal birth after cesarean, global) | $2,330.71 | $2,330.71 | 69.78 |
| 59025 | Fetal non-stress test | $50.44 | $50.44 | 1.51 |
| 57454 | Colposcopy with biopsy | $166.00 | $118.91 | 4.97 |
| 58558 | Hysteroscopy with biopsy | $1,269.90 | $204.41 | 38.02 |
| 58571 | Laparoscopic hysterectomy | $828.68 | $828.68 | 24.81 |
| 76801 | OB ultrasound, first trimester | $116.90 | $116.90 | 3.50 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the OB/GYN billing services page.
Modifiers That Prevent OB/GYN Denials
A separately identifiable problem visit during pregnancy that is not part of routine antepartum care, distinct from the global package.
A significant, separately identifiable E/M on the same day as a procedure such as a colposcopy or IUD insertion.
Increased procedural work, such as a complex cesarean or extensive lysis of adhesions, with an operative note that quantifies the added effort.
Multiple procedures in the same surgical session, applied to the secondary procedures per payer rules.
A repeat procedure by the same (76) or different (77) physician, such as a repeat ultrasound, with the medical reason documented.
Split obstetric care: surgical-only (54) or postpartum-only (55) when a patient transfers between practices mid-care.
Top OB/GYN Denials → Quick Fix
Routine prenatal visits are in the global package. Bill a separate visit only for a distinct problem, documented as unrelated to routine care.
Link a covered indication for 76801 series studies. Routine serial ultrasounds without a documented indication are denied.
Document the abnormal Pap or clinical finding that justifies 57454. A screening-driven colposcopy with no indication is denied.
The approach in the op note (laparoscopic, vaginal, abdominal) must match the code billed. A mismatch is a coding-error denial.
When a patient transfers, bill only the portion you provided using modifier 54, 55, or the antepartum-only codes. Billing a full global you did not provide is an incorrect-billing denial and a recoupment risk.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 59400 | 01958 | Anesthesia service included in surgical procedure |
| 59400 | 01960 | Anesthesia service included in surgical procedure |
| 59510 | 01958 | Anesthesia service included in surgical procedure |
| 59510 | 01961 | Anesthesia service included in surgical procedure |
| 59610 | 01958 | Anesthesia service included in surgical procedure |
| 59610 | 01960 | Anesthesia service included in surgical procedure |
| 59025 | 0213T | Misuse of Column Two code with Column One code |
| 59025 | 0216T | Misuse of Column Two code with Column One code |
Documentation That Holds Up on Appeal
The count of antepartum visits, the delivery type, and postpartum care, so a transfer or complication can be billed correctly out of the global.
The indication, trimester, complete versus limited, and whether it is a repeat with a stated medical reason.
The abnormal Pap or clinical finding that established medical necessity.
Surgical approach and uterine weight where the code set distinguishes by it.
The high-risk condition coded as a secondary diagnosis so additional monitoring is supported.
Revenue OB/GYN Practices Leave on the Table
Folding a distinct problem visit during pregnancy into the global instead of billing it separately with documentation.
Not capturing antepartum-only or postpartum-only codes when a patient transfers in or out mid-care.
Under-documenting cesarean complexity that would support modifier 22.
Missing separately billable services such as fetal non-stress tests (59025) that are not part of the global.
OB/GYN Billing FAQ
What is included in the global obstetric package?
Routine antepartum visits, the delivery, and routine postpartum care. Distinct problem visits, most ultrasounds, non-stress tests, and complications are outside it and billed separately when documented.
How do we bill a patient who transferred mid-pregnancy?
Bill only the portion you provided. Use antepartum-only codes for the visits you did, or modifier 54 and 55 to split surgical and postpartum care. Billing a full global you did not provide denies as CO-18.
When can we bill an OB ultrasound separately?
When it has a documented indication. The code, trimester, and complete-versus-limited status must match the documentation, and a repeat needs a stated medical reason.
Why are colposcopies denied for medical necessity?
Because the abnormal Pap or clinical finding that justifies the procedure was not documented or linked. A colposcopy needs a qualifying result on the chart.
Stop Losing OB/GYN Revenue to Preventable Denials
Our AAPC-certified ob/gyn coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.