OB/GYN billing for practices and groups: global obstetric care, deliveries and care split between practices, ultrasounds and high-risk visits, well-woman and preventive visits, contraception, and gynecologic procedures and surgery, worked inside the software you already use.
OB/GYN billing services turn every pregnancy, visit and procedure into a paid claim. Prenatal care, delivery and postpartum care are tracked as one package and billed when it is complete, preventive and problem visits are kept apart, and every payment, denial and patient balance is followed until it is resolved.
40.2%
of US births in 2024 were paid for by Medicaid, so most obstetric practices work with state Medicaid rules as well as commercial plans
3.6M
births were registered in the US in 2024, each with prenatal, delivery and postpartum care to bill
Obstetric care is billed as one package that spans nine months. A routine pregnancy’s prenatal visits, the delivery and the postpartum care are billed together with one global code after the baby is born, so nothing is paid for months, and the claim has to account for every visit. When a patient changes practices, changes insurance or delivers somewhere else, the package has to be split into the parts each practice provided. Add ultrasounds and high-risk visits billed outside the package, Medicaid programs that pay their own way, and gynecology and preventive visits with their own rules, and the timeline decides many claims.
Who provided which part of the pregnancy decides the claim. That is why we track every pregnancy from the first visit and bill the package, or its parts, the way each payer requires.
Most OB/GYN practices bill obstetric care, gynecology and preventive visits in the same week, often for the same patient.
Pays forPrenatal visits, vaginal or cesarean delivery and postpartum care, billed as a global package, or in parts when care is split.
Where it breaks
What we do
Pays forProblem visits, colposcopy, endometrial biopsy, hysteroscopy, and gynecologic surgery with its global period.
Where it breaks
What we do
Pays forWell-woman visits, cervical cancer screening, and contraception such as IUDs and implants, usually without cost sharing for the patient.
Where it breaks
What we do
For a routine pregnancy, one code covers the prenatal visits, the delivery and the postpartum care: 59400 for a vaginal delivery, 59510 for a cesarean, and 59610 or 59618 after a previous cesarean. The claim is sent once, after the delivery, and the routine prenatal visits are not billed on their own. Ultrasounds, lab work, non-stress tests and visits for problems outside a routine pregnancy are billed separately.
When care is split, each practice bills only what it provided. Prenatal care alone is billed by the number of visits: office visit codes for one to three, 59425 for four to six, and 59426 for seven or more. A delivery by another practice is billed with a delivery-only code such as 59409 or 59514, or with postpartum care included, and postpartum care alone is 59430. Some Medicaid programs and plans ask for prenatal visits to be billed as they happen, so we follow each payer’s own rules.
What we do: we open a record for each pregnancy at the first visit, with the payer, the expected delivery date and every visit and test. After the delivery, we bill the global code or the parts each practice provided, add the services billed outside the package, and check for payer changes during the pregnancy so nothing is billed to the wrong plan.
OB/GYN claims follow each pregnancy as a package, alongside gynecology visits, procedures and preventive care. Below are the ones we see most and what payers look for. Commercial plans and Medicaid programs add their own rules, and we check each one.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | Problem visits; modifier 25 when a problem visit and a procedure or preventive visit happen the same day. |
| 5940059510 | Global obstetric care: vaginal and cesarean delivery | Billed once after the delivery, with prenatal and postpartum care included. |
| 5961059618 | Global care for a vaginal or cesarean delivery after a previous cesarean | The same package rules, with the history documented. |
| 5942559426 | Prenatal care only, four to six and seven or more visits | When another practice delivers or the patient transfers; one to three visits use office visit codes. |
| 594095951459430 | Vaginal delivery only, cesarean delivery only, and postpartum care only | For split care, each billed by the practice that provided it. |
| 76801768057681576817 | Obstetric ultrasounds | Billed outside the package, by trimester and type, with the reason documented. |
| 59025 | Fetal non-stress test | Billed separately from the package, with the indication documented. |
| 99384 to 99397G0101Q0091 | Preventive visits: commercial well-woman visits, and Medicare pelvic and breast exam and Pap collection | Medicare pays G0101 and Q0091 every 24 months, or every 12 months for high-risk patients. |
| 58300J7296 to J7301 | IUD insertion and the device | The insertion and the device on separate lines; the device code matches the brand inserted. |
| 11981J7307 | Contraceptive implant insertion and the implant | Billed together; removal with reinsertion has its own code. |
| 574545810058558 | Colposcopy with biopsy, endometrial biopsy, and hysteroscopy with sampling | Coded by what was done; a same-day visit only when it is separate. |
A problem visit on the same day as a preventive visit or a procedure, when it is significant and separate. Modifier 25 explained
Commercial plans: a preventive service, such as contraception or screening, billed without cost sharing.
Medicaid programs that use it: marks prenatal and postpartum services as obstetric care.
A delivery or surgery that took substantially more work than usual, with the reason documented.
Two procedures normally bundled, done at separate sites or sessions. Our modifier 59 guide
An assistant at a cesarean or gynecologic surgery, where the payer allows one.
Sources: CPT maternity care and delivery guidelines; Medicare Claims Processing Manual, chapter 18 (preventive services); Medicare NCCI Policy Manual, chapter VII (female genital system and maternity care); state Medicaid obstetric billing manuals. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, obstetric packages and split care, preventive visits, contraception, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list every active pregnancy and its expected delivery date, and agree how escalations work. Most practices are live within one to two weeks.
Visits, deliveries and procedures are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, obstetric packages, preventive visits and device lines checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Birth center
OB/GYN practices bill global obstetric packages that pay months after care begins, alongside gynecology and preventive visits. Fee models vary: a percentage of collections, a flat monthly amount or a charge per claim. A percentage keeps the fee tied to what those packages and visits actually pay.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What moves the number for an OB/GYN practice is the mix of obstetric, gynecology and preventive work, delivery volume, how much Medicaid you see, and how clean the receivables are when we take them on, which is why we quote your exact rate after the free account review, not before.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, obstetric packages and split care, preventive visits and contraception, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
Not only have they helped us streamline our operations, but their expertise has also maximized our revenue cycle, allowing us to focus more on patient care. The level of communication is outstanding; we always feel informed and supported.