OB-GYN billing and revenue cycle, 50-state coverage.
Ob-gyn and women's health billing services from ASP-RCM Solutions. 24,728 NPPES OB-GYN billing providers across all 50 states + DC. HIPAA + SOC 2 Type II compliant. Senior partners on every account.
What good OB-GYN billing execution looks like.
The operating discipline we install on every OB-GYN billing engagement.
- Global OB package billing and antepartum visit trackingGlobal OB package (59400, 59510, 59610, 59618) bundles antepartum, delivery, and postpartum care. OB-GYN practices need accurate antepartum visit tracking to determine global vs separate billing.
- Newborn delivery coding for vaginal vs C-sectionVaginal delivery (59409 with global, 59410 with postpartum) vs C-section (59514, 59515) carry distinct codes. Twin and complex deliveries add code complexity.
- Ultrasound and antepartum diagnostic billingOB ultrasound (76801-76817) and BPP, NST, and antepartum surveillance billing require precise study-type coding and appropriate modifier use.
- Annual well-woman visit + preventive codingAnnual well-woman visit (99396-99397, plus G0101 / Q0091 for Medicare screening pap) bills distinctly from problem-oriented visits. Modifier 25 needed when same-day E/M occurs.
- LARC and contraception codingIUD insertion (58300), removal (58301), and Nexplanon (11981-11983) plus device J-codes (J7297, J7298, J7300, J7301) require accurate placement and inventory billing.
- Pelvic surgery and laparoscopic procedure codingHysterectomy, myomectomy, oophorectomy, and pelvic floor procedures carry complex code stacks with bundling rules. OB-GYN practices doing surgery need specialty coders.
Demonstration dashboard
What an OB-GYN revenue picture looks like when it is instrumented.
Every ASP-RCM OB-GYN engagement ships a live Power BI revenue dashboard, drillable to the claim, the global package and the provider. Below is the demonstration build we walk prospects through.
- KPI header: cash posted MTD, clean claim rate, days in AR, denial rate, global package tracking, net collection rate
- Cash posted across the last twelve months, plotted against the plan line
- Revenue mix by service line: global OB packages, gyn surgery, well-woman and preventive, OB ultrasound, LARC and other
- Top denial reasons ranked by share: global OB miscount, carve-out billed inside the global, delivery and VBAC code selection, preventive versus problem, LARC device not billed
- Claims by status by payer across commercial, Medicaid, Medicaid MCO, Medicare and TRICARE, split clean, pending, review and denied
- Days in AR distribution with a median marker against a 42-day target
- Operations counters for the day: global packages tracked, carve-outs captured, deliveries coded, LARC devices billed, OB ultrasounds, appeals won
- Payer performance table: claim volume, clean rate, denial rate, average payment and AR days by payer
- Compliance strip carrying the audits and memberships ASP-RCM holds
Your build is live to you inside 21 days and refreshes on a schedule you set. Ask for the walkthrough.
The rules you are billing under
Six things an OB-GYN practice should know cold.
Each item below carries its source. We do not publish benchmarks or rules we cannot point at.
Routine obstetric care billed as one code: antepartum care, vaginal delivery and postpartum care. The cesarean, VBAC and attempted VBAC equivalents are 59510, 59610 and 59618.
AMA CPT, Maternity Care and Delivery guidelinesMedicaid finances more than two out of every five births in the United States, which is why obstetric payer mix and Medicaid managed care rules drive OB-GYN cash more than most specialties.
MACPAC, Medicaid's Role in Maternal Health59425 reports antepartum care only for 4 to 6 visits and 59426 for 7 or more. One to three antepartum visits are reported as individual E/M services instead. Counting visits is therefore a billing decision, not an afterthought.
AMA CPT, Maternity Care and Delivery guidelinesACOG recommends contact with an obstetric care provider within the first 3 weeks postpartum, with a comprehensive postpartum visit no later than 12 weeks after birth. Postpartum care is inside the global package; 59430 reports it when it is not.
ACOG Committee Opinion 736, Optimizing Postpartum Care (2018)76811 is the detailed fetal anatomic examination, distinct from the standard 76801 and 76805 studies and the 76816 follow-up. Frequency and who may report it are set in each payer's own medical policy, so ultrasound rules have to be held payer by payer.
AMA CPT, diagnostic ultrasound guidelines; individual payer medical policyOB-GYN billing organizations registered across all 50 states and DC. ASP-RCM publishes a field guide for every one of them.
NPPES registry, ASP-RCM specialty universe buildRevenue leakage taxonomy
The five places OB-GYN revenue actually leaks.
OB-GYN denials are not random. They cluster around one structural fact: the global obstetric package is a bundle, and almost every leak is a bundle decision made wrong or made late. This is the taxonomy we work against on every OB-GYN engagement.
| Leakage driver | How the dollars go missing | The pre-bill control we install | Fixable pre-bill |
|---|---|---|---|
| Antepartum visit miscountGlobal versus 59425, 59426 or E/M | The patient transfers in, transfers out, or delivers elsewhere, and the practice bills the full global package for care it did not fully render. Or the reverse: 7 antepartum visits get billed as individual office visits when 59426 was the correct claim. | A running antepartum visit counter per pregnancy, checked against the 4 to 6 and 7 or more thresholds before any maternity claim is released. | Yes |
| Carve-outs billed inside the globalServices the bundle never included | Ultrasound, non-stress testing, amniocentesis, high-risk management and problem visits unrelated to the pregnancy are absorbed into the global fee. The work is done, documented and never separately billed. | A carve-out screen at the visit, so separately reportable services are flagged at the point of care rather than reconstructed from the chart months later at delivery. | Yes |
| Delivery route and shared care mismatchGlobal versus delivery only | Care is shared across practices or the delivery route changes, and the claim still goes out as a global package. Delivery-only and delivery-plus-postpartum codes exist precisely for this, and they are the codes most often skipped. | A care-continuity check before the maternity claim: who rendered antepartum, who delivered, who is rendering postpartum, and which of the global, delivery-only or delivery-plus-postpartum codes the answer actually supports. | Yes |
| Preventive and problem on the same dayWell-woman plus a problem E/M | A well-woman visit turns up a problem that is worked up in the same encounter. Either the problem E/M is never billed, or it is billed without the modifier and documentation that make it separately identifiable, and the payer bundles it. | Same-day preventive and problem logic in the pre-bill review, with documentation that carries a distinct history, assessment and plan for the problem before the modifier is ever appended. | Yes |
| Ultrasound frequency and code selection76801, 76805, 76811, 76816 | The wrong study type is reported for the gestational age, the detailed anatomic exam is repeated beyond what the payer's medical policy allows, or the professional and technical split is never applied when the practice does not own the equipment. | A payer-specific ultrasound frequency matrix held current per plan, plus a code-selection gate at order entry that pins study type to gestational age and to who owns the equipment. | Yes |
This table describes ASP-RCM's operating taxonomy and the controls we install. It does not assert denial frequencies. Denial mix is measured per practice during the free 30-day audit against your own last 90 days of claim data.
Money map
From positive test to cash posted.
Five stages. Three leak points. Every leak is a bundling decision that gets made at the visit and discovered at the claim, which is why working OB-GYN denials after submission never gets a practice to a clean net collection rate.
Top OB-GYN billing markets by NPPES org count.
State-level RCM guides for the largest OB-GYN billing markets in the U.S.
OB-GYN billing FAQ
Questions OB-GYN practice leaders actually ask.
What does the global obstetric package include, and when should it be unbundled?
The global package covers routine antepartum care, the delivery itself and routine postpartum care under a single code: 59400 for vaginal delivery, 59510 for cesarean, 59610 for vaginal birth after cesarean and 59618 for an attempted VBAC that becomes a cesarean. It should be unbundled whenever the practice did not render all three components, when care was shared with another practice, or when the patient transferred in or out mid-pregnancy. Billing a global package for care you did not fully render is the single most common OB-GYN claim defect, and the correction is a care-continuity check before the claim goes out, not an appeal after it comes back.
How are antepartum visits counted for billing?
The count decides the code. One to three antepartum visits are reported as individual evaluation and management services. Four to six visits are reported with 59425, antepartum care only. Seven or more are reported with 59426. Because the boundary sits between visits, the count has to be maintained live per pregnancy rather than reconstructed at delivery, which is when most practices discover the number moved and the claim they were about to file was the wrong one.
When do you bill delivery only instead of the global package?
When your practice performed the delivery but not the full course of antepartum and postpartum care. CPT provides delivery-only codes and delivery-plus-postpartum codes for exactly this situation, separately for vaginal delivery, cesarean and vaginal birth after cesarean. This comes up constantly in call-group arrangements, hospitalist deliveries, laborist coverage and any practice taking transfers late in pregnancy. The determining question is not who saw the patient most, it is which components of the bundle your practice actually rendered.
Is postpartum care billed separately?
Not when it is inside the global package, which already includes routine postpartum care. It is billed separately with 59430, postpartum care only, when your practice provides postpartum care but did not deliver, or when the delivery was billed on a delivery-only code. Worth noting on the clinical side: ACOG recommends contact with an obstetric care provider within the first three weeks postpartum and a comprehensive visit no later than twelve weeks after birth, so postpartum is a course of care rather than one visit, and the billing has to reflect whichever of those touches your practice actually owns.
Why do OB ultrasound claims deny?
Three reasons dominate. The study type does not match the gestational age, so a first trimester code is reported for a second trimester study or the reverse. The detailed fetal anatomic examination, 76811, is repeated beyond what the payer's medical policy allows, since it is a specialized study rather than the routine anatomy scan. Or the professional and technical components are never split when the practice reads a study on equipment it does not own. All three are knowable before submission, because frequency limits and component rules sit in each payer's published medical policy rather than in a national standard.
OB/GYN billing by state.
Dedicated OB/GYN billing and credentialing field guides for 51 states. Each state guide opens into its city-level guides with local payer, Medicaid, and credentialing detail.
- Alabama 4 cities
- Alaska 3 cities
- Arizona 9 cities
- Arkansas 3 cities
- California 15 cities
- Colorado 11 cities
- Connecticut 3 cities
- Delaware 3 cities
- District of Columbia 1 city
- Florida 15 cities
- Georgia 11 cities
- Hawaii 3 cities
- Idaho 3 cities
- Illinois 7 cities
- Indiana 6 cities
- Iowa 3 cities
- Kansas 3 cities
- Kentucky 3 cities
- Louisiana 6 cities
- Maine 3 cities
- Maryland 13 cities
- Massachusetts 3 cities
- Michigan 15 cities
- Minnesota 3 cities
- Mississippi 3 cities
- Missouri 4 cities
- Montana 3 cities
- Nebraska 3 cities
- Nevada 3 cities
- New Hampshire 3 cities
- New Jersey 7 cities
- New Mexico 3 cities
- New York 14 cities
- North Carolina 13 cities
- North Dakota 1 city
- Ohio 9 cities
- Oklahoma 3 cities
- Oregon 9 cities
- Pennsylvania 10 cities
- Rhode Island 3 cities
- South Carolina 7 cities
- South Dakota 2 cities
- Tennessee 4 cities
- Texas 15 cities
- Utah 3 cities
- Vermont 3 cities
- Virginia 11 cities
- Washington 9 cities
- West Virginia 3 cities
- Wisconsin 3 cities
- Wyoming 3 cities