OB/GYN Billing Services

When the Global OB Package Breaks: Billing Split Maternity Care and 12-Month Postpartum Medicaid

The short answer: keep the global obstetric package (CPT 59400 / 59510 / 59610) only when one practice provides all antepartum, delivery, and postpartum care under one continuous payer. The moment coverage changes mid-pregnancy, a different group renders delivery, or postpartum care runs into the extended 12-month Medicaid window, you must unbundle into antepartum (59425 / 59426), delivery-only (59409 / 59514), and postpartum-only (59430) components. Bill what your provider actually did, not the whole arc.

CPT 59400 to 59622 Split antepartum / delivery / postpartum 12-month postpartum Medicaid Cross-payer maternity

The decision, up front

Global or split? Read the two columns before you touch a claim

The global maternity package assumes one continuous relationship. Two conditions break that assumption: the care fragments across providers, or the payment fragments across payers. Either one flips you to component billing.

STAY GLOBAL

Bill 59400 / 59510 / 59610

Same practice provides antepartum, delivery, and routine postpartum
One payer covers the entire episode start to finish
Uncomplicated routine care, typical 13-plus antepartum visits
No mid-pregnancy transfer, no plan change, no coverage gap

UNBUNDLE

Split into components

Patient changes payer mid-pregnancy (Medicaid to commercial, plan to plan)
Another group or hospitalist performs the delivery
Patient transfers in or out of your practice partway through
Postpartum care extends into the 12-month Medicaid window
Fewer than four antepartum visits with your practice (bill E/M, not 59425)

Interactive coding tool

Global Package Splitter

Answer four questions the way the chart reads. The panel maps your inputs to the correct CPT path per the AMA maternity guidelines. Illustrative logic, not a payer contract.

Map the episode to the right codes

CPT 59400 to 59622

1 · Antepartum visits with your practice

2 · Who performed the delivery

3 · Delivery route

4 · Payer continuity across the episode

Recommended path

59400Routine obstetric care, global vaginal package

Reference

The maternity code family, decomposed

Every global code has component siblings. When you split, you pick one code per phase your provider actually rendered.

CPT	Descriptor	When you use it
Global packages
59400	Routine OB care, vaginal delivery, antepartum + postpartum	Full episode, one practice, one payer
59510	Routine OB care, cesarean, antepartum + postpartum	Full cesarean episode, one practice
59610	Routine OB care, VBAC delivery, ante + postpartum	Full VBAC episode, one practice
59618	Routine OB care, cesarean after attempted VBAC, ante + postpartum	Attempted VBAC converted to cesarean
Antepartum only
59425	Antepartum care only, 4 to 6 visits	Partial prenatal care, mid-range visit count
59426	Antepartum care only, 7 or more visits	Most prenatal care, no delivery by you
E/M	Office / outpatient E/M (99202 to 99215)	1 to 3 antepartum visits only, per visit
Delivery only / delivery + postpartum
59409	Vaginal delivery only	You deliver, someone else did prenatal/postpartum
59410	Vaginal delivery including postpartum care	You deliver and manage postpartum, not prenatal
59514	Cesarean delivery only	Delivery only, cesarean
59515	Cesarean delivery including postpartum	Cesarean + postpartum, not prenatal
59612 / 59614	VBAC delivery only / with postpartum	VBAC split delivery scenarios
Postpartum only
59430	Postpartum care only	You manage postpartum, another group delivered

The episode, with fracture points

Where a maternity episode splits

Flagged steps are the moments the global package quietly stops being correct. Catch them at intake, not at denial.

First OB visit + coverage confirmed

Verify eligibility and the payer that will own delivery. Set the global-versus-split flag here.

Coverage change mid-pregnancy

Medicaid to marketplace, employer plan switch, or presumptive eligibility ending.

SPLIT: 59425/59426 to old payer

Transfer of care in or out

Patient moves practices, or a covering group performs the delivery.

SPLIT: delivery-only 59409/59514

Delivery event

Route and provider determine 59409/59410 vaginal or 59514/59515 cesarean when unbundled.

Postpartum extends past 60 days

Care continues into the 12-month Medicaid postpartum window under a distinct benefit.

SPLIT: postpartum-only 59430 + E/M

The window that changed everything

12-month postpartum Medicaid coverage

POSTPARTUM COVERAGE HORIZON

Delivery60 days (legacy)12 months

The Consolidated Appropriations Act, 2023 made the American Rescue Plan Act state option to extend Medicaid and CHIP postpartum coverage from 60 days to a full 12 months permanent. The overwhelming majority of states have adopted it. The billing consequence: postpartum care no longer ends when the global package assumed it did.

Why it forces component billing

The global obstetric package bakes in one postpartum episode of routine care. Care rendered under the extended 12-month window is frequently a separate covered benefit, not the postpartum bundled into 59400.

Operator rule: routine postpartum tied to the delivery stays inside the global or maps to 59430 when unbundled. Care delivered later in the 12-month window is billed as E/M and problem-specific services under the postpartum benefit, coded to the diagnoses that support it, per your state Medicaid OB billing manual.

Confirm the effective date and any managed-care carve-outs in your state manual. Adoption dates and coding instructions differ state to state.

The four-step check

Run every maternity chart through this

STEP 01Did one practice render all three phases? No means split.

STEP 02Did the payer stay the same start to finish? A change means split per payer.

STEP 03Count antepartum visits: 1 to 3 E/M, 4 to 6 = 59425, 7+ = 59426.

STEP 04Is postpartum inside 60 days or the 12-month window? Route accordingly.

What goes wrong

The four ways split maternity claims fail

None of these are exotic. They are the predictable result of billing the whole arc when your provider only owned part of it.

FAILURE 01Global billed after a mid-care transferYou submit 59400 but only did prenatal. Payer recoups the delivery and postpartum portions.

FAILURE 0259425/59426 for fewer than four visits1 to 3 antepartum visits must be individual E/M. The block code denies.

FAILURE 03Global spanning two payersOne package straddling a coverage change gets denied by both. Split by payer of record per phase.

FAILURE 04Postpartum in the 12-month window billed as bundledLater postpartum care coded into 59400 is written off instead of billed as separate covered E/M.

FAILURE 05Double-counted postpartum59410 or 59430 stacked on top of a global that already includes postpartum.

FAILURE 06Wrong delivery-only siblingVaginal 59409 vs cesarean 59514 vs VBAC 59612 mismatched to the actual route.

Cite the source, every time

2026 guidelines this page rests on

Authoritative references

AMA CPT

AMA CPT Maternity Care and Delivery, codes 59400 to 59622. Defines the global obstetric package and its antepartum-only, delivery-only, delivery-plus-postpartum, and postpartum-only component codes. The governing source for what the package includes and how to unbundle it.

CAA 2023

Consolidated Appropriations Act, 2023, extended postpartum coverage. Made permanent the American Rescue Plan Act state option to extend Medicaid and CHIP postpartum coverage from 60 days to 12 months. Confirm your state adoption status.

STATE

State Medicaid OB billing manual and 12-month postpartum extension policy. Governs component coding rules, managed-care carve-outs, visit-count thresholds, and how care in the extended postpartum window is billed in your state. Always the controlling instruction for Medicaid maternity claims.

CMS

CMS Medicaid postpartum coverage guidance and state plan amendment tracking. The federal framework behind state adoption of the 12-month extension and the eligibility basis for the separate postpartum benefit.

Verify effective dates, visit thresholds, and modifier requirements against your current state Medicaid manual and payer contracts before submitting. Coding instructions vary by state and payer.

Stop writing off the phases your OB providers actually earned

ASP-RCM Solutions builds the intake flags, split-billing logic, and payer-of-record rules into your OB/GYN workflow so global-versus-component decisions happen before the claim goes out, not after the denial. We reconcile antepartum visit counts, cross-payer episodes, and the 12-month postpartum window against your state Medicaid manual on every chart.

Talk to our OB/GYN billing team →