The Complete Guide to Global and Non-Global Obstetric Billing

Global obstetric billing has long been the standard model used in maternity care billing, grouping together antepartum care, delivery and postpartum care into one global OB billing claim, the CPTs being bundled together in this model are: CPT 59400, CPT 59510, CPT 59610 and CPT 59618. But in the era of payers transitioning to phase-based payment, and separate reporting for prenatal, delivery and postpartum care, non-global obstetric billing is gaining in significance.

The change has occurred in Texas Medicaid; global OB codes are no longer reimbursable. Antepartum care, labor management, delivery only codes and postpartum care must be billed separately. Starting January 1, 2027, the 2027 global OB code transition, which is approved by the AMA, will officially remove several global obstetric package codes and introduce new OB code maternity care billing codes designed around granular reporting and E/M documentation. 

For OBGYN practices and billing companies, this change will dramatically increase coding complexity, documentation requirements, and claim management workloads, creating a growing demand for specialized obstetric billing services and accurate non-global maternity billing workflows.

What Is Global and Non-Global Obstetric Billing?

Global obstetric billing is a bundled maternity care billing model where all routine pregnancy services are reported under a single CPT code. In traditional global OB billing, codes such as CPT 59400, CPT 59510, CPT 59610, and CPT 59618 include antepartum care, labor and delivery, and postpartum care within one global obstetric package. This model applies only when the same physician or group practice manages the patient throughout the full pregnancy cycle.

Non-global obstetric billing (split or unbundled maternity billing) refers to the billing of each component of the care provided. In lieu of a single bundled claim, providers submit antepartum and delivery-only codes, postpartum and individual E/M services. This method is now gaining traction, thanks to payer-specific regulations and the impending 2027 global OB code migration. 

The Four Global OB CPT Codes

The AMA recognizes four global obstetric CPT codes, each covering the complete maternity package but differentiated by delivery type:

CPT Code	Full Description	When to Use
CPT 59400	Routine obstetric care – antepartum care, vaginal delivery (with or without episiotomy and/or forceps), and postpartum care	Uncomplicated vaginal delivery – same provider for all care
CPT 59510	Routine obstetric care – antepartum care, cesarean delivery, and postpartum care	Uncomplicated C-section – same provider for all care
CPT 59610	Routine obstetric care, including antepartum care, vaginal delivery after previous cesarean (VBAC), and postpartum care	VBAC – successful vaginal delivery after prior C-section
CPT 59618	Routine obstetric care – antepartum care, cesarean delivery, and postpartum care following attempted VBAC	Attempted VBAC that ended in repeat C-section
⚠️  Billing Rule: Never bill global OB codes with additional E/M codes for the same routine prenatal visits. Those visits are already bundled inside the global package.

Non-Global Obstetric Billing Codes

Rather than a single CPT code, providers have different codes for prenatal, delivery-only, and postpartum care, and using the right code and providing correct documentation. 

Antepartum (Prenatal) Non-Global Codes

CPT 99202–99215 – Individual Prenatal E/M Visits

These office or outpatient E/M codes are used when a patient receives 1–3 prenatal visits only. Each visit is billed separately based on medical decision-making or total time documented.

CPT 59425 – Antepartum Care (4–6 Visits)

Used when a provider performs 4 to 6 prenatal visits but does not deliver the baby. It represents partial antepartum care only.

CPT 59426 – Antepartum Care (7+ Visits)

Used when a provider performs 7 or more prenatal visits but another provider completes the delivery.

Billing Rule: CPT 59425 and 59426 cannot be used together for the same pregnancy. Routine E/M codes are also not separately billable with these antepartum packages by the same provider.

Texas Medicaid Rule: Antepartum global codes (59425, 59426) are not reimbursed. Each prenatal visit must be billed individually using E/M codes with Modifier TH.

Delivery – Only Non-Global Codes

CPT 59409 – Vaginal Delivery Only

Used when a provider performs only the vaginal delivery, without providing prenatal care.

CPT 59514 – Cesarean Delivery Only

Used for C-section delivery only, when antepartum care was not managed by the delivering provider.

CPT 59612 – VBAC Delivery Only

Used when the provider performs a successful vaginal birth after cesarean (VBAC) without managing prenatal care.

CPT 59620 – Failed VBAC (Cesarean Delivery)

Used when a VBAC attempt fails and results in a cesarean delivery by the delivering provider only.

Billing Rule: Delivery only: Labor management from hospital admission to delivery completion is included. Antepartum/postpartum services shall be billed separately as appropriate.

The Texas Medicaid Rule: Modifier U1, U2, or U3 is needed for delivery claims. Common reasons for denial of modifiers are missing modifiers.

Postpartum – Only Non-Global Code

CPT 59430 – Postpartum Care Only

Used when a provider performs postpartum follow-up care only and was not involved in the delivery.

CPT 99202–99215 – Postpartum E/M Visits

Used for postpartum complications such as infection, hypertension, or depression when medical necessity is documented.

Billing Rule: CPT 59430 cannot be used by the same provider who already billed a global OB package because postpartum care is already included in bundled maternity reimbursement.

Services Included in the Global Package

The following services are global OB payment components and should not be billed separately per CPT guidelines and ACOG:

All routine antepartum visits after first three antepartum visits. 

• Weight and blood pressure recording at each visit
• Fetal heart tone documentation
• Routine chemical urinalysis (CPT 81000, 81002)
• Hospital admission history and physical
• Inpatient E/M service provided within 24 hours of delivery
• Management of uncomplicated labor
• The delivery itself, vaginal or cesarean
• Repair of first- and second-degree lacerations
• Uncomplicated inpatient visits following delivery
• Routine outpatient E/M services within 42 days postpartum (CPT 59430)

Services Excluded – Bill These Separately

The following services are never included in the global OB package, regardless of when they occur during pregnancy:

• The first three antepartum E/M visits (bill with appropriate E/M codes)
• All laboratory tests (prenatal panel, GBS, glucose tolerance)
• All maternal and fetal ultrasound procedures (CPT 76801, 76805, 76811, 76816, etc.)
• Amniocentesis (CPT 59000) and chorionic villus sampling (CPT 59015)
• Fetal non-stress test (CPT 59025) and biophysical profile (CPT 76818, 76819)
• External cephalic version (CPT 59412)
• Cerclage placement (CPT 59320, 59325)
• E/M services for conditions unrelated to the pregnancy (e.g., UTI, asthma, flu)
• E/M services for complications requiring more than the standard 13 visits
• Long-acting reversible contraception (LARC) at delivery
• Epidural anesthesia billed by the anesthesiologist

Audit Tip  Document every excluded service with a diagnosis code that clearly supports why it is outside the normal pregnancy course. Payers will scrutinize separately billed services during a maternity claim audit.

Modifier Usage in Global Obstetric Billing

Using modifiers in obstetric claims is essential to claim accuracy and to avoid claim denials. Modifiers exist in both the global OB and non-global obstetric billing scenarios to help indicated if a service is part of the maternity package, separately billable, or if the service is too complex or clinically necessary and requires additional documentation. 

Incorrect or missing modifiers are one of the most common reasons for payment delays and denials in OBGYN billing practices, especially during the ongoing transition toward phase-based maternity coding.

Modifier TH – Maternity / Obstetric E/M Visits (2026 Transition)

During the transition period (2026-2027), modifier TH should be added to the E/M codes to help to distinguish maternity-related visits. It provides clarity to help payers recognize prenatal care as distinct from regular office visits as care moves from a global OB bill to visit-based reimbursement. 

Modifier 22 – Increased Procedural Complexity

Modifiers are used to adjust the code when a procedure is performed at a higher level of effort, for example, modifier 22 is added to the global OB or delivery codes. This could involve complicated cesarean, long labor management, high adhesion or unexpected complications during the operation. There needs to be good documentation that supports reimbursement for extra services. 

Modifier 25 – Significant, Separately Identifiable E/M Service

Modifier 25 is applied when the provider provides a separate evaluation and management (E/M) service on the same date as a procedure. For obstetric care, it is used when an obstetric examination and management of a condition are performed during a routine prenatal visit, and the condition is unrelated or separately identifiable from the obstetric visit and is not included in the global package. 

Modifier 59 – Distinct Procedural Service

Modifier 59 means that a service is separately performed and not included in the procedures on the same date. It is used for external cephalic version, amniocentesis, and non-stress testing (NST) in obstetrics, but is not part of the same service bundle as the prenatal visits. 

ICD-10 Diagnosis Codes for Global Obstetric Billing

Every global OB claim must be supported by the correct ICD-10-CM diagnosis code. Here are the most commonly used codes for routine maternity care:

Z34.x – Supervision of Normal Pregnancy

Use Z34 codes for routine prenatal visits in uncomplicated pregnancies. The code is stratified by trimester and whether the pregnancy is the patient’s first:

• Z34.00–Z34.03 – Supervision of normal first pregnancy, by trimester
• Z34.10–Z34.13 – Supervision of normal subsequent pregnancy, by trimester
• Z34.80–Z34.83 – Supervision of other normal pregnancy, by trimester
• Z34.90–Z34.93 – Supervision of unspecified normal pregnancy, by trimester

O80 – Normal Delivery

Use O80 as the principal diagnosis on the delivery claim for a completely uncomplicated vaginal delivery of a single liveborn infant at term. If O80 is used, no other O-codes should appear on the same claim. Always add:

• A Z3A.xx code indicating the weeks of gestation at delivery
• A Z37.0 code (single liveborn infant, delivered vaginally) as a secondary diagnosis

Important ICD-10 Rules for 2026

New pelvic pain codes (R10.21–R10.24) require laterality – the old R10.2 code is no longer acceptable.

Post-abortion hemorrhage must be coded as O04.6, not as postpartum hemorrhage O72.1.

When a high-risk patient delivers without complications, the delivery is coded as O80 rather than as a high-risk encounter.

Common Global OB Billing Mistakes and How to Fix Them

Global obstetric billing errors are one of the biggest reasons for claim denials, revenue leakage and compliance risks in OBGYN practices. The most common errors are when OB providers combine global OB billing rules with non-global OB billing rules; and when documentation does not support the billing of services for the global OB codes, CPT 59400, CPT 59510, and other maternity codes. 

Below are the most frequent global OB billing mistakes and the correct way to fix them for accurate reimbursement and compliant coding.

Billing routine prenatal E/M visits in addition to the global code

One of the most common errors is billing routine prenatal E/M visits separately while also reporting a global obstetric code. In global OB billing, routine antepartum visits are already included in the bundled package.

Using the wrong delivery code when care is split

Another frequent mistake occurs when providers use global codes like CPT 59400 even though the patient’s care was split between multiple providers.

Failing to use Modifier TH during the 2026 transition

Many practices do not adequately identify E/M visits that are related to pregnancy when moving from the global to non-global transition period.

Fix:

For maternity E/M visits use HCPCS Modifier TH. Review and update all EHR templates and billing workflows to ensure they are being applied consistently according to Payer rules. 

Missing documentation for services billed outside the global package

One of the more frequent compliance problems involves billing for services without an obvious clinical need. 

Fix:

All services that are billed separately from the global obstetric package should be accompanied by supporting documentation and a diagnosis that explicitly states the medical necessity for services beyond routine prenatal care.

Incorrectly billing CPT 59425 and CPT 59426 together

Certain practices incorrectly submit all antepartum codes for the same pregnancy. 

Fix:

CPT 59425 and CPT 59426 are mutually exclusive. Only one antepartum-only code should be used per pregnancy per provider, depending on the number of prenatal visits performed.

Using O codes instead of Z34.xx for routine prenatal visits

Another coding error is for using normal pregnancy complication-based ICD-10 O codes for normal pregnancy encounters. 

Fix:

Apply Z34.xx ICD-10 codes for routine supervision of pregnancy. Save the O codes for complications or high-risk conditions that need medical intervention.

Payer-Specific Rules for Global Obstetric Billing

Not every insurance company uses global obstetric billing in the same manner. The CPT codes governing the reimbursement of global OB services, including CPT 59400, CPT 59510, CPT 59610 and CPT 59618, are well defined in the guidelines; however, each payor may have different interpretations regarding maternity reimbursement. In both global and non-global obstetric billing models, having a clear understanding of the policies of payers is crucial to preventing denials, avoiding underpayments and maintaining compliance. 

UnitedHealthcare (UHC)

UnitedHealthcare is following the ACOG guidelines when it comes to maternity reimbursements, and it’s basically following the standard rules for OB billing in the rest of the world. If the CPT codes 59400, 59510, 59610 and 59618 are used separately, they are considered to be a single package of routine antepartum, delivery, and postpartum services from a single practice. 

Key billing rule:

Routine prenatal E/M visits cannot be billed separately when a global OB code is used, as they are already included in the global obstetric package reimbursement.

Medicaid Programs

Medicaid policies differ from state to state, but many policies are already moving away from the old global OB billing models and are now moving towards itemized maternity billing. 

In these systems, each phase of care, antepartum visits, delivery services, and postpartum care, must be billed separately using appropriate E/M codes, delivery-only codes, and postpartum billing codes.

Important billing risk:

Submitting global OB codes to a Medicaid program that follows an itemized billing model can result in automatic claim denial or payment recovery.

Commercial Payers – General Billing Variations

Commercial insurance payers do not always follow a single standardized approach to maternity reimbursement. Practices must always review payer-specific maternity billing policies before claim submission.

Common variations include:

• Whether the first 1–3 prenatal visits are reimbursed separately or included in the global OB package
• Variations in split billing if a patient transfers care mid-pregnancy.Variations in split billing if patient transfers care mid-pregnancy.
• Specific preauthorization requirements for high-risk pregnancy billing services

Due to these variations, payer policy verification is a critical process in both global and non-global OB workflows to guarantee that claims are submitted correctly, and denials are prevented. 

CureCloudMD Expert Approach to Global & Non-Global Obstetric Billing

The ability to execute global obstetric (OB) codes and non-global OB codes accurately depends on having a strong grasp of the payer landscape, being up to date on payer CPT changes and adhering to the changing rules for maternity reimbursement. The move from bundled maternity billing (CPT 59400, 59510, 59610, 59618) to phase-based obstetric billing (antepartum, delivery, postpartum separation) has greatly increased the potential for claim errors, particularly during the transition period in 2026 and 2027.

CureCloudMD‘s specialized OBGYN revenue cycle team supports the expert billing framework, which is structured for coding accuracy, maps to specific payers’ rules, and is constantly updated with ACOG and AMA guidance. This will make sure that all claims follow the current global OB billing guidelines, non-global maternity billing guidelines and payer-specific reimbursement guidelines like Medicaid, commercial insurers, or OB-specific systems based on transitional E/M.

OB Billing Workflow (Global + Non-Global)

The CureCloudMD OB billing process aims to removes common denial triggers like incorrect global code usage, missing modifiers (TH, 25, 59, U-series), and improper split billing scenarios.

Key operational strengths include:

• Real time validation of global obstetric package eligibility of non-global OB billing requirements.
• Automated separation of antepartum billing codes, delivery-only codes, and postpartum services
• Strict documentation review with ICD-10 pregnancy coding (Z34.xx, O codes where applicable)
• A Payer-specific rule enforcement for Medicaid non-global OB billing model and commercial payer variations.
• Pre-billing audit checks to ensure compliance with 2027 global OB code deletion readiness

Revenue Cycle Impact and Denial Reduction Strategy

The most common reason for revenue leakage in obstetric billing is when the OB revenue is incorrectly bundled, modifiers are missing, or the provider doesn’t recognize that global OB billing may not apply. Unlike more traditional methods of claim corrections, CureCloudMD’s structured approach aims to prevent denials before they occur. 

This methodology directly supports:

• Higher clean claim submission accuracy
• Reduced claim rework cycles
• Faster payer reimbursement timelines
• Improved cash flow predictability for OBGYN practices

Although the results can vary according to payer mix, practice size and documentation, structured OB billing workflows such as this are broadly linked to a substantial enhancement in claim acceptance performance and less denial exposure, particularly in intricate pregnancy billing scenarios with split care and high-risk pregnancies. 

Why OB Billing Accuracy Directly Impacts Revenue?

Obstetric billing is one of the most financially sensitive areas in healthcare revenue cycle management because each pregnancy involves multiple billable phases and strict payer rules. Errors in global OB billing, non-global OB billing codes, or modifier application can disrupt the entire reimbursement cycle across 9 months of care.

CureCloudMD keeps OBGYN practices financially stable and up to date on 2027 maternity billing changes, ACOG/AMA updates, and CPT deletions.

Outcome-Focused Billing Intelligence

The main goal of this structured billing model isn’t simply compliance, it’s revenue optimization for healthcare providers that is sustainable. Practices benefit when global OB billing is converted to non-global, phase billing:

• Increased transparency on reimbursement for service-level.
• Greater accuracy in documentation for each encounter
• Enhanced readiness to undergo payer audit
• Better revenue cycle performance will be achieved.The revenue cycle will be more predictable. 

Email us at [email protected] or call +1 205 947 3264 to start transforming your practice’s financial performance. Your revenue growth and financial peace of mind are our top priorities.