OB/GYN Billing · Global vs Itemized

Global OB package or itemize? The transferred-care decision that changes your whole claim.

The answer first: bill the global obstetric package only when one physician or group provided substantially all antepartum, delivery, and postpartum care. The moment a patient transfers in or out mid-pregnancy, the global codes are wrong for at least one provider. Itemizing antepartum visits and a delivery-only code is not a downgrade. It is the only compliant path, and it is often the higher-paying one.

59400 global vaginal 59510 global cesarean 59610 global VBAC 59425 / 59426 antepartum only 59409 / 59514 / 59612 delivery only

The global package is not a code. It is a promise that your practice held the entire pregnancy. Break the promise, and the code breaks with it. The rule under every transferred-care claim

The archetype

One patient, two practices, and the claim that quietly overbills

Meet the "Relocating Mother" archetype. She starts prenatal care with Practice A at 9 weeks, moves across the state at 30 weeks, and delivers with Practice B. Neither practice held the whole pregnancy. If either one bills global, the claim is wrong.

Shared care, split down the middle

CPT defines the global obstetric package as routine antepartum care, delivery, and postpartum care by the same physician or group. When care splits, so must the coding.

Weeks 9 to 30

Practice A · Antepartum only

1 2 3 4 5 6 7

59426 Antepartum care only, 7 or more visits

Weeks 30 to delivery

Practice B · Remaining care plus delivery

1 2 3 4 DELIVERY

59409 Vaginal delivery only, plus antepartum E/M for its own visits

If Practice B bills 59400 global, it is billing for antepartum care it never rendered. That is an overpayment on audit and a takeback waiting to happen. Practice A, meanwhile, leaves earned antepartum revenue on the table if it never files 59426.

The decision, in three questions

Ask these before you touch a global code

Did one physician or group provide all three phases?

Antepartum, delivery, and postpartum, by the same tax ID and specialty group.

Yes
Bill global. 59400 vaginal, 59510 cesarean, or 59610 vaginal after prior cesarean.

No, care was shared
Stop. Global is off the table. Go to question 2.

Did your practice perform the delivery?

Separate the delivery event from the prenatal visits you actually saw.

Yes, we delivered
Use a delivery-only code: 59409, 59514, or 59612, then add your antepartum visits by count.

No, we only saw prenatal
Bill antepartum only by visit count. Go to question 3.

How many antepartum visits did you document?

The count decides the code. This is where Medicaid rules bite hardest.

4 to 6 visits
Bill 59425, antepartum care only. 1 to 3 visits bill as individual E/M.

7 or more visits
Bill 59426, antepartum care only, once per pregnancy.

The code map

Global on the left. What you actually bill when care splits, on the right.

Global code	Covers	When care splits, bill instead
Vaginal delivery pathway
`59400`	Routine obstetric care: antepartum, vaginal delivery, and postpartum	Antepartum only: `59425` (4 to 6) or `59426` (7+). Delivery only: `59409`. Delivery plus postpartum: `59410`.
Cesarean delivery pathway
`59510`	Routine obstetric care: antepartum, cesarean delivery, and postpartum	Antepartum only: `59425` / `59426`. Delivery only: `59514`. Delivery plus postpartum: `59515`.
Vaginal birth after cesarean (VBAC) pathway
`59610`	Routine obstetric care: antepartum, vaginal delivery after previous cesarean, and postpartum	Antepartum only: `59425` / `59426`. Delivery only: `59612`. Delivery plus postpartum: `59614`.
Postpartum, when that is all you did
`—`	Postpartum care only, outpatient	Bill `59430` for postpartum-only visits when another practice handled antepartum and delivery.

Note the trap in the VBAC row. A patient who attempts VBAC but converts to cesarean is not 59610. That delivery-only scenario is 59620, cesarean following attempted vaginal delivery after previous cesarean. The wrong assumption here is a common denial.

Payers do not read your intent. They read your visit count. The antepartum threshold is not paperwork. It is the difference between 59425 and 59426, and between paid and pended. Why the Medicaid count rule earns its own section

Medicaid: delivery-only and antepartum-count rules

State Medicaid does not follow the commercial global habit

Many state Medicaid programs require delivery-only and itemized antepartum billing rather than the global package, and they hold the CPT visit thresholds strictly. Check your state Medicaid provider manual and OB/maternity billing policy before you assume global. The count of documented antepartum visits, not the calendar, sets the code.

4–6

59425

Antepartum care only

Four to six documented antepartum visits. Report once for the range, not per visit. One to three visits are billed as individual evaluation and management services instead.

59426

Antepartum care only

Seven or more documented antepartum visits, reported once per pregnancy. This is the code Practice A earns in the transferred-care archetype above.

Watch two things that vary by state: whether Medicaid pays delivery-only codes (59409 / 59514 / 59612) plus separate antepartum, or bundles differently, and whether your program caps antepartum visits or requires a maternity risk-screening modifier. The CPT definitions are national. The billing mechanics are state law.

Sources you can cite in an appeal

Real guidelines behind every rule on this page

CPT 2026, AMA

Maternity Care and Delivery guidelines

Define the global obstetric package (59400, 59510, 59610), the antepartum-only codes 59425 and 59426, delivery-only codes 59409, 59514, 59612, 59620, and postpartum-only 59430, with the "same physician or group" condition for global.

ACOG

ACOG coding guidance and the Ob-Gyn Coding Manual

ACOG Committee on Coding and Nomenclature guidance on splitting the global package for transferred and shared care, and on counting antepartum visits. The reference operators reach for when a payer disputes an itemized OB claim.

State Medicaid

State Medicaid OB / maternity billing policy

Your state Medicaid provider manual sets delivery-only and antepartum-count rules, whether global is accepted, visit caps, and any maternity or risk-screening modifiers. These override commercial global habits for Medicaid members.

CMS

Medicare Physician Fee Schedule 2026 and NCCI

For fee-schedule valuation of the global versus itemized OB codes and the National Correct Coding Initiative edits that govern bundling when antepartum and delivery services are reported separately.

Every transferred-care pregnancy is a coding decision your team makes under time pressure.

ASP-RCM Solutions builds the antepartum-count logic, the delivery-only splits, and the state Medicaid rules directly into your OB/GYN billing workflow, so global versus itemized is decided correctly the first time, not discovered on audit. Fewer takebacks, cleaner claims, and the antepartum revenue you actually earned.

Talk to our OB/GYN billing team → ASP-RCM Solutions · OB/GYN Billing Services