OB/GYN Billing Services // 2026 Update

The OB Global Package in 2026: Every Visit That Is Already Paid, and Every One That Is Not

Most OB revenue leaks in the same two places: encounters billed separately that were already inside the global fee, and encounters written off that could have unbundled. Here is the whole pregnancy, mapped.

The short answer: Under AMA CPT 2026, the global maternity codes 59400, 59510, and 59610 pay one fee for routine antepartum care, the delivery, and uncomplicated postpartum care. Everything outside "routine" (the pregnancy-confirmation visit, ultrasounds, non-stress tests, problem visits, transferred care, and postpartum problems after the standard follow-up window) can bill on its own line. The trick is knowing which is which before the claim goes out.
Inside the global fee (already paid)
Outside the global fee (bills separately)

One Pregnancy, Every Encounter Mapped

Follow a routine pregnancy from the first positive test to the extended postpartum period. Blue nodes are already bundled into 59400 / 59510 / 59610. Gold nodes leave the package and earn their own reimbursement.

1
Unbundles

Visit to confirm the pregnancy

The initial E/M that establishes pregnancy is not part of the global package. Bill the office visit (99202-99215) plus the confirmatory lab or ultrasound. Once care is confirmed and the OB record opens, the global clock starts.

2
Inside 59400/59510/59610

Routine antepartum visits

The recurring prenatal schedule (roughly monthly, then biweekly, then weekly) is bundled. CPT counts about 13 routine visits inside the global fee. Do not bill these E/M encounters separately.

3
Unbundles

Obstetric ultrasounds and NSTs

Imaging and antepartum testing are never inside the package. Dating and anatomy scans (76801-76817) and non-stress tests (59025) bill on their own, each with a documented order and interpretation.

4
Unbundles

Problem visits beyond routine care

A visit for a condition that is not part of routine prenatal management (hyperemesis, threatened preterm labor, an unrelated infection) is separately reportable with the E/M code and a clear, distinct diagnosis. Document why the encounter falls outside the schedule.

5
Inside the global fee

Admission and delivery

The admission history and physical, management of uncomplicated labor, and the delivery itself are all inside the global code: vaginal in 59400, cesarean in 59510, and vaginal after prior cesarean in 59610.

6
Inside the global fee

Uncomplicated postpartum care

Routine postpartum follow-up after discharge is bundled into the same global fee. The standard package covers the uncomplicated postpartum course, typically through the routine follow-up visit around six weeks.

7
Unbundles

Postpartum problems and extended visits

A new or ongoing problem after the routine follow-up (wound complication, postpartum depression management, hypertension follow-up) is a separate E/M, not part of the global package. The extended Medicaid coverage window keeps the patient eligible for these encounters.

8
Coverage window, not global window

Months 2 through 12 postpartum

Medicaid postpartum coverage now runs a full 12 months in adopting states. That is an eligibility window, not an extension of the global package. Encounters here bill as ordinary E/M for the presenting problem.

The Three Global Codes You Are Choosing Between

59400

Routine vaginal delivery

Global obstetric care, vaginal delivery.

  • Antepartum care (routine visits)
  • Vaginal delivery
  • Postpartum care
59510

Routine cesarean delivery

Global obstetric care, cesarean delivery.

  • Antepartum care (routine visits)
  • Cesarean delivery
  • Postpartum care
59610

Vaginal after prior cesarean

Global care, VBAC delivery.

  • Antepartum care (routine visits)
  • Vaginal delivery after previous cesarean
  • Postpartum care

The Inside / Outside Line, on One Screen

When your coders hesitate, this is the split they are hesitating over. Print it and tape it to the monitor.

Already paid by the global fee

  • •
    Routine antepartum visits (about 13 in the standard schedule)Do not report these as separate E/M
  • •
    Admission history and physical for delivery
  • •
    Management of uncomplicated labor and the delivery
  • •
    Routine, uncomplicated postpartum follow-up
  • •
    Fetal heart monitoring by the delivering provider during labor

Bills separately, legitimately

  • +
    Pregnancy-confirmation E/M visit and its labBefore the global record opens
  • +
    Obstetric ultrasounds 76801-76817 and non-stress tests 59025
  • +
    Visits for problems outside routine prenatal careDistinct diagnosis required
  • +
    Amniocentesis, external cephalic version, and other procedures
  • +
    Postpartum problem visits after the routine follow-up
  • +
    Care for conditions unrelated to the pregnancy

Where teams get 2026 wrong

Twelve months of coverage is not twelve months of global package

Under the American Rescue Plan option made permanent by the Consolidated Appropriations Act, 2023, states can extend Medicaid and CHIP postpartum coverage to a full 12 months, and the large majority now do. That change is about who stays eligible, not about what the global fee includes.

The global maternity code still covers only the routine, uncomplicated postpartum course. Every postpartum problem visit that happens during the extended window is a separate, billable E/M encounter tied to its own diagnosis. Bundling those into the delivery fee is money handed back for free.

RULE: coverage window ≠ global window. Bill postpartum problems as E/M.

When Care Is Split: The Carve-Out Codes

If your practice did not provide the whole package, you do not bill the whole package. Match what you actually delivered to the right partial-care code.

What you providedCodeHow to report it
Antepartum care only, 1 to 3 visits99202-99215Report as E/M visits; there is no global antepartum code at this low visit count.
Antepartum care only, 4 to 6 visits59425One unit for the antepartum block. Do not add per-visit E/M on top.
Antepartum care only, 7 or more visits59426One unit for the full antepartum block when the practice did not deliver.
Delivery only, vaginal59409Delivery without antepartum or postpartum care (patient transferred in near term).
Delivery only, cesarean59514Cesarean delivery only, no global antepartum or postpartum.
Delivery only, VBAC59612Vaginal delivery after prior cesarean, delivery only.
Postpartum care only59430Report when your practice provided postpartum care but not the delivery.

2026 Guidelines This Page Is Built On

CPT® 2026
AMA CPT 2026, Maternity Care and Delivery. Global obstetric codes 59400, 59510, and 59610, plus antepartum-only 59425 / 59426, delivery-only 59409 / 59514 / 59612, and postpartum-only 59430. The section guidelines define what routine antepartum, delivery, and postpartum care the global fee includes.
CMS / Medicaid
Medicaid and CHIP 12-month postpartum coverage extension. The American Rescue Plan Act state option, made permanent by the Consolidated Appropriations Act, 2023, lets states extend postpartum coverage to 12 months. Confirm the current window and any billing guidance in your state Medicaid provider manual, since adoption and detail vary by state.
Carve-out
Transferred and partial-care billing. When a single practice does not furnish the complete antepartum-delivery-postpartum package, CPT directs use of the component codes above rather than the global code. This is the standard basis for shared-care and transfer-of-care claims across commercial and Medicaid payers.

Stop Guessing at the Inside / Outside Line

ASP-RCM Solutions builds this map into your OB/GYN billing workflow: every routine visit bundled correctly, every ultrasound, non-stress test, problem visit, and transfer of care carved out and captured, and every extended-window postpartum encounter billed instead of written off. Fewer bundling denials, cleaner claims, more of the reimbursement you already earned.

Map your OB global package with us

OB/GYN billing services from ASP-RCM Solutions. Frisco, Texas.

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