OB/GYN billing has a feature that no other specialty really deals with: the global maternity package. This single billing concept bundles months of care into one code and one payment. It covers prenatal visits, the delivery itself, and postpartum follow-up. In theory, it simplifies things. In practice, it creates more billing confusion than almost anything else in the specialty.
Most billing errors in OB/GYN practices trace back to the global package. Practices either leave money on the table by not billing separately for services that fall outside the bundle, or they bill incorrectly for services that are included and end up with denials and refund requests. Let us go through how the package actually works and where the mistakes happen.
What the Global Package Includes
The global obstetric package is defined by CPT codes 59400 (vaginal delivery), 59510 (cesarean delivery), and 59610 (VBAC delivery). Each of these codes bundles three phases of care into a single charge.
The antepartum phase includes routine prenatal visits from the initial confirmation of pregnancy through the last visit before delivery. The delivery phase includes admission to the hospital, management of labor, and the delivery itself. The postpartum phase includes routine follow-up care through approximately six weeks after delivery.
When a provider manages all three phases for a patient, the global code is billed after delivery. The payer makes one payment that covers the entire episode. The practice does not bill separately for each prenatal visit or the postpartum check. It is all rolled into that one code.
When Care Gets Split Between Providers
Here is where it starts to get messy. Not every patient stays with the same provider for the entire pregnancy. A patient may transfer from another practice partway through the prenatal phase. She may deliver at a hospital where a different OB is on call. Or she may move to a new city and establish care with a new provider for the remainder of her pregnancy and delivery.
When the global package is split, each provider bills only for the phase of care they actually provided. CPT codes exist for antepartum-only care (59425 for 4 to 6 visits, 59426 for 7 or more visits), delivery-only (59409 for vaginal, 59514 for cesarean), and postpartum-only (59430).
The mistake practices make is billing the full global code even when they did not manage all three phases. If a provider only handled the antepartum visits and the delivery was done by someone else, the global code is wrong. The payer will eventually catch it, especially if the delivering provider also submits a claim. Now both claims are flagged, and both providers deal with delays and corrections.
Services That Fall Outside the Bundle
This is where practices leave the most money behind. The global package covers routine prenatal visits, but it does not cover everything that happens during a pregnancy. Conditions that arise during pregnancy and require separate evaluation and management are billable outside the global package.
Gestational diabetes management, preeclampsia monitoring, hyperemesis treatment, and evaluation of complications like preterm labor are all separately billable when documented as distinct from routine prenatal care. The E/M visit for these conditions is billed with the appropriate diagnosis code and, in some cases, modifier 25 if a routine prenatal visit also occurred on the same day.
Many OB/GYN practices do not bill for these separately because the billing team is unsure about what falls inside and outside the bundle. The result is that the provider performs additional work for a high-risk pregnancy but receives only the global package payment. Over the course of a year, across dozens of complicated pregnancies, the revenue loss adds up.
Ultrasounds, Labs & Non-Routine Testing
Routine labs ordered during prenatal care are not part of the global package and are billed separately. The same goes for ultrasounds. A standard anatomy scan at 20 weeks, a dating ultrasound in the first trimester, and any additional imaging for fetal monitoring are all billed with their own CPT codes.
The billing issue comes when the practice fails to submit these charges because someone on the team assumes they are included in the bundle. They are not. Every ultrasound performed during pregnancy should be billed to the payer with the appropriate CPT code, diagnosis, and documentation.
Non-stress tests, biophysical profiles, and fetal echocardiograms are also separate charges. For high-risk pregnancies that require frequent monitoring, these services can account for a significant portion of the total revenue from that patient’s care.
Postpartum Visit Billing After 2021 CPT Changes
The postpartum visit was reevaluated by CPT starting in 2021, and this change still causes confusion. The postpartum visit included in the global package is a routine follow-up within the standard postpartum period. If the provider addresses a separate condition during the postpartum visit, such as postpartum depression screening, wound complications from a cesarean, or a new gynecologic issue, that evaluation can be billed separately with modifier 24 to indicate it is unrelated to the obstetric global period.
Some payers accept this split and some push back, so the documentation has to clearly support that the additional service was distinct from routine postpartum care.
Payer Variations That Catch Practices Off Guard
Not all payers handle the global maternity package the same way. Medicare rarely covers obstetric care, so most OB/GYN billing goes to commercial and Medicaid plans. Medicaid managed care plans in Texas each have their own rules about when to submit the global charge, how to handle split care, and what documentation is required for antepartum-only billing.
Some commercial payers require the practice to submit an estimated delivery date and expected global charge at a specific point in the pregnancy, often around the 28th week. If this submission is missed, the claims process differently and payments are delayed. Other payers want monthly charge submissions during the antepartum phase rather than a single global charge after delivery.
Knowing what each payer expects and building the billing workflow around those expectations prevents delays and denials. Practices that apply a one-size-fits-all approach to maternity billing across all payers will always leave money behind.