OB/GYN CPT Reference

OB/GYN CPT Codes and Reimbursement Rates

OB/GYN billing spans prenatal care, labor and delivery, gynecological procedures, and preventive women health services across the full patient lifecycle.

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OB/GYN CPT Codes and Reimbursement Rates
500+

Practices Supported

98.2%

Clean Claim Rate

$2.4M

Revenue Recovered

24hr

Claim Submission

Overview

The Complexity of OB/GYN billing

OB/GYN billing spans prenatal care, labor and delivery, gynecological procedures, and preventive women health services across the full patient lifecycle. The global obstetric package (59400-59622) is one of the most complex billing constructs in medicine, bundling antepartum visits, delivery, and postpartum care into a single reimbursement amount.

This reference covers the CPT codes used most frequently in OB/GYN practices. Each section addresses global package rules, carve-out procedure billing, gynecological surgery codes, and preventive screening billing to help your practice capture all billable services accurately throughout each phase of care.

The Complexity of OB/GYN billing
Challenges

Common OB/GYN billing Challenges We Solve

Every OB/GYN billing team deals with payer delays, coding nuance, and collection leakage.

Authorization Gaps

We identify missing authorizations and documentation gaps before they create denials.

Coding Drift

Procedure coding and modifier use stay aligned with payer rules.

Aging AR

We actively work unresolved balances so claims do not sit untouched.

Patient Collections

Clear statements and follow-up plans reduce missed payments.

Services

Complete OB/GYN billing Services

Support spans the full revenue cycle.

Eligibility verification and benefits checks

Specialty-specific coding review

Electronic claim submission within 24 hours

Denial management and appeals

Payment posting and reconciliation

Weekly reporting and revenue reviews

Coverage

Serving OB/GYN billing Teams Nationwide

We support independent practices and growing provider organizations.

Independent physician groups

Multi-location practices

Private equity backed platforms

Hospital-owned outpatient groups

Guide

The Complete Guide to OB/GYN billing

OB/GYN CPT Code Categories

OB/GYN billing straddles two distinct service lines: obstetric care with its global packaging rules and gynecologic services billed per encounter. Understanding when the global obstetric package applies and when services are billed individually is the most critical distinction in OB/GYN coding. Getting this wrong either leaves revenue uncollected or creates compliance exposure from unbundling services that should be packaged.

Global Obstetric Package Codes

The global obstetric package bundles antepartum care, delivery, and postpartum care into a single code. Vaginal delivery (59400) reimburses approximately $2,300 under Medicare and includes all routine antepartum visits (typically 13), the delivery, and postpartum care through 6 weeks. Cesarean delivery (59510) reimburses approximately $2,700. Vaginal delivery after previous cesarean (59610) reimburses approximately $2,500.

The global package creates a timing challenge for billing. The practice does not submit the claim until after delivery, meaning revenue for months of antepartum care is delayed until the delivery event. Cash flow management requires tracking the expected delivery dates across the patient panel and forecasting the associated revenue.

Antepartum-Only and Postpartum-Only Codes

When a patient transfers care during pregnancy, the transferring provider bills antepartum-only codes based on the number of visits provided: 59425 (4-6 visits, approximately $450) or 59426 (7+ visits, approximately $750). The receiving provider bills the delivery and postpartum components. Postpartum-only care uses 59430 (approximately $200).

Gynecologic Procedure Codes

Gynecologic procedures are billed per encounter, not globally. Colposcopy with biopsy (57454) reimburses approximately $200. Endometrial biopsy (58100) reimburses approximately $135. LEEP procedure (57522) reimburses approximately $350. Hysteroscopy with biopsy (58558) reimburses approximately $450. These procedures generate significant revenue when performed in-office rather than in a hospital outpatient setting.

Preventive and E/M Visits

Annual well-woman exams use preventive visit codes (99384-99397 by age group) and include the pelvic exam, breast exam, and preventive counseling. When a problem is addressed during the same visit (abnormal bleeding, contraception management), an E/M code with modifier 25 can be billed in addition to the preventive code. This split billing is one of the most frequently missed revenue opportunities in OB/GYN.

Obstetric Ultrasound

OB ultrasound codes differ from general radiology ultrasound. First trimester ultrasound (76801) reimburses approximately $120. Detailed fetal anatomy scan (76811) reimburses approximately $195. Limited OB ultrasound (76815) reimburses approximately $70 and is used for focused assessments (fetal heart rate, amniotic fluid). Practices that own ultrasound equipment bill the global code; those using hospital equipment bill modifier 26 for professional interpretation only.

Common Questions

Frequently Asked Questions About OB/GYN billing

Answers to the questions practice owners ask most often.

The global OB package (59400, 59510, 59610) includes all routine antepartum visits after the initial visit (typically 13 visits), the delivery (vaginal or cesarean), and postpartum care through 6 weeks. Complications, hospital admissions for conditions unrelated to normal pregnancy, and non-routine services are billed separately outside the global package.

Bill antepartum-only codes (59425 for 4-6 visits, 59426 for 7+) when the patient transfers to another provider before delivery. The number of antepartum visits provided determines the code. The receiving provider bills the delivery and postpartum components. If the patient transfers back before delivery, the original provider may bill the global package instead.

Not for routine antepartum care, which is included in the global package. However, if a complication arises during an antepartum visit that requires additional evaluation and management beyond routine care (gestational diabetes management, preeclampsia evaluation), the E/M visit for the complication can be billed separately with the appropriate complication diagnosis code and modifier 25.

If the practice owns the ultrasound equipment and the physician performs and interprets the study, bill the global OB ultrasound code (76801, 76805, 76811, 76815). If the physician only interprets images from hospital or external equipment, bill with modifier 26. Standard OB ultrasound at specific gestational ages is included in the global OB package under some payer policies. Check each payer to determine which ultrasounds are included vs. separately billable.

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