OB/GYN Billing · 2026

The 12-month postpartum extension quietly reopened 10 months of billable visits.

If your state adopted the Medicaid 12-month postpartum extension, your patient stays covered from day 61 through day 365. The global OB package still ends where it always did. Everything the mother needs in that gap is now a separately payable visit, if you code it that way.

The short answer: The global obstetric package (CPT 59400, 59510, 59610, 59618) still bundles routine antepartum, delivery, and uncomplicated postpartum care. The extension does not enlarge that bundle. It extends eligibility, so postpartum E/M for new or unrelated problems, chronic-condition management, behavioral health, and contraception fall outside the package and bill on their own.

60 → 365

Days of Medicaid postpartum coverage under the extension

48 + DC

States with 12-month extension implemented (KFF tracker, 2026)

4 codes

Global OB package CPTs that define what is already bundled

Mod 24

The modifier that unbundles unrelated postpartum E/M

The state map

Coverage is now near-universal. Billing behavior has not caught up.

Nearly every state took the permanent option created by the American Rescue Plan Act and locked in by the Consolidated Appropriations Act, 2023. Where you practice decides whether day-90 depression care is a covered claim or a write-off.

12-month postpartum extension implemented Limited / pending — verify current SPA status

Northeast

Midwest

South

West

Tiles are grouped by U.S. Census region, not geographic shape, and reflect the national picture reported on the KFF Postpartum Coverage tracker and Medicaid.gov for 2026. State status changes as State Plan Amendments are approved. Confirm your own state's current window in its Medicaid provider manual before you rework claims, especially for the states flagged for verification.

The unbundling line

What stays in the global package vs. what you bill outside it

The AMA CPT global obstetric package has not moved. The only thing that changed is how long the patient stays enrolled, which turns the right column into paid claims instead of unfunded goodwill.

Inside the global OB package

Already bundled — do not bill again

Routine antepartum care (the standard visit schedule)
Vaginal or cesarean delivery 59400 59510
VBAC and cesarean-after-VBAC 59610 59618
The uncomplicated postpartum visit within the routine period
Routine pain and wound checks tied to the delivery

day 61+

Outside the package once coverage extends

Separately payable — code it

Unrelated or new-problem E/M in the postpartum period 99202-99215 + -24
Chronic-condition management: hypertension, diabetes, thyroid
Postpartum depression / anxiety screening and management
Contraception counseling and LARC 11981 58300 + device
Additional problem-focused visits beyond the routine postpartum care
Postpartum-only care when you did not do the delivery 59430

The billable set

Four visit types the extension makes payable

These are the encounters that most often get absorbed into the delivery global and never billed. In an extension state, each is its own line with its own coverage.

99213-24

Unrelated E/M

Modifier 24 signals an E/M during the postpartum period for a problem unrelated to the delivery. Documentation must show the separate reason.

96161

Depression screen

Standardized postpartum depression screening, with follow-up management billed as its own E/M when the visit addresses treatment.

58300

LARC placement

IUD or implant insertion plus the device supply code. Frequently carved out of the global and separately reimbursable postpartum.

59430

Postpartum only

When your group did not perform the delivery, postpartum care stands alone rather than folding into a global you never billed.

The clock

Two windows, one delivery date

The global package covers the routine postpartum period. The extension governs everything after, and that is where the recoverable revenue lives.

DAY 0 – ~60

Global OB package

Delivery plus the routine postpartum visit are bundled into 59400 / 59510 / 59610 / 59618. Rebilling any of this is a denial or a takeback.

DAY 61 – 365 · EXTENSION WINDOW

Separately billable postpartum care

The patient stays Medicaid-enrolled for a full year. New-problem E/M with modifier 24, chronic disease management, behavioral health, and contraception are covered claims, not charity. This is the stretch most OB groups still write off out of habit from the 60-day era.

Sources by name

The 2026 guidance this sits on

ARPA §9812 state option — American Rescue Plan Act created the option to extend Medicaid/CHIP postpartum coverage from 60 days to 12 months.

Consolidated Appropriations Act, 2023 §5113 — made the 12-month postpartum extension a permanent state option.

Medicaid.gov Postpartum Coverage — CMS guidance on extended coverage and approved State Plan Amendments.

KFF Postpartum Coverage tracker (2026) — state-by-state implementation status, updated as SPAs are approved.

AMA CPT global obstetric package — 59400, 59510, 59610, 59618 define bundled maternity care; 59430 for postpartum-only.

CPT modifier 24 + ACOG postpartum guidance — unrelated E/M during the postpartum period and the standard for unbundling.

We map your states, then rebuild the postpartum claim logic behind them.

Most OB groups lost the day-61-to-365 window before it existed, and never turned it back on. ASP-RCM Solutions audits your delivery globals against each state's current extension status, flags the postpartum E/M, LARC, and behavioral-health encounters your billers are still absorbing, and rewires the edits so the covered visits actually go out the door.

Book an OB postpartum billing review →

Coding examples are illustrative and reflect published 2026 CMS, Medicaid, AMA CPT, and ACOG guidance. State coverage status changes with each approved State Plan Amendment. ASP-RCM validates payer and state rules against your own Medicaid provider manual before any claim change.