Ask ten people in a medical billing department what the global OB package includes, and you’ll likely get several different answers.
That’s because OB/GYN global billing can be surprisingly complex. While the global package is designed to simplify reimbursement by bundling prenatal care, delivery, and postpartum services into a single payment structure, confusion about what is and isn’t included often leads to billing errors.
Mistakes such as incorrect coding, missed documentation, or overlooking separately billable services can result in denied claims, delayed payments, and lost revenue. Many practices don’t discover these issues until they begin affecting cash flow and overall financial performance.
Understanding how global OB billing works is essential for maintaining compliance and maximizing reimbursement. In this guide, we’ll cover what the global package includes, what can be billed separately, documentation requirements, and the most common billing mistakes obstetrics practices should avoid.
To learn how billing mistakes impact healthcare practices across different specialties, Read More.
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What Is the Global OB Billing Package?
The global OB package, also known as the global maternity fee or global obstetric care package, is a bundled billing arrangement that covers most routine maternity services provided throughout a patient’s pregnancy, delivery, and postpartum recovery.
Instead of billing separately for every prenatal visit, the delivery itself, and postpartum follow-up care, providers submit a single global billing code that combines these services into one reimbursement package. This approach simplifies the billing process for both healthcare providers and payers while helping ensure continuity of care throughout the pregnancy journey.
The most commonly used global OB CPT codes include:
59400: Routine obstetric care, including antepartum care, vaginal delivery, and postpartum care
59510: Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care
59610: Routine obstetric care for vaginal birth after cesarean (VBAC), including antepartum and postpartum care
59618: Obstetric care for an attempted VBAC that results in a cesarean delivery, including antepartum and postpartum care
Each of these codes represents a complete episode of routine obstetric care. The bundled reimbursement typically includes prenatal visits, delivery services, and postpartum care provided by the same physician or group practice.
One important aspect of global OB billing is that reimbursement is generally received after delivery. Rather than submitting claims for each routine visit during the pregnancy, the practice bills the global package once the delivery has occurred, covering the entire course of care within a single claim.
While this system can streamline reimbursement and reduce administrative work, it also requires accurate documentation and a clear understanding of which services are included in the global package and which services must be billed separately.
What the Global Package Actually Includes
Understanding what is included in the global OB package is essential because billing separately for services already covered by the global fee is one of the most common OB billing mistakes.
Antepartum Visits
The global package includes routine prenatal care throughout the pregnancy, including the initial prenatal visit and approximately twelve to fourteen follow-up visits. Since these visits are bundled into the global fee, they should not be billed separately.
Delivery Services
The delivery itself is included in the global package, whether it is a vaginal birth or a cesarean section. This covers the physician’s services related to managing and performing the delivery.
Postpartum Care
Routine postpartum care is also part of the global package. This typically includes one postpartum visit performed four to six weeks after delivery. Because it is bundled into the global reimbursement, it should not be billed separately.
A clear understanding of these included services helps practices avoid claim denials, duplicate billing, and reimbursement issues.
What Is Not Included in the Global Package
Many OB billing mistakes happen because practices assume every pregnancy-related service is covered under the global package. In reality, several services can and should be billed separately.
High-Risk Pregnancy Management
Care provided for complications such as gestational diabetes, preeclampsia, preterm labor, or severe hyperemesis gravidarum is not included in the global package. These services require separate billing with the appropriate diagnosis and procedure codes.
Additional Prenatal Visits
If a patient needs more prenatal visits than the standard global package allows, those extra visits may be billed separately when properly documented.
Ultrasounds and Diagnostic Testing
Services such as anatomy scans, growth ultrasounds, and biophysical profiles are not included in the global OB fee. These diagnostic services should be billed separately and are often a source of missed revenue.
Fetal Monitoring Services
Non-stress tests, contraction stress tests, and other fetal monitoring services are also separately billable, especially for high-risk pregnancies that require frequent monitoring.
Hospital and Surgical Services
Antepartum hospital admissions for pregnancy complications, cerclage procedures, and surgical complications that require additional treatment are not part of the global package and should be billed separately when appropriate.
Knowing which services fall outside the global OB package helps practices capture legitimate reimbursement while avoiding costly billing errors.
How the Global Package Works When Multiple Physicians Are Involved
One of the more challenging aspects of OB/GYN global billing is managing cases where multiple physicians are involved in a patient’s care. In today’s obstetrics practices, it is common for patients to see different providers throughout their pregnancy due to group practice structures, on-call coverage, and hospital-based delivery models.
When care is shared, there are generally two billing approaches:
Shared Antepartum Care Billed to the Delivering Physician
In many group practices, the physician who performs the delivery bills the global OB package, even if other providers handled some of the prenatal visits. This approach requires clear internal documentation and tracking to ensure the correct physician submits the global claim.
Split Care Billed Separately
When a patient transfers to another practice during pregnancy, the global package is typically divided. The original practice bills for the prenatal care already provided using antepartum care codes such as 59425 or 59426, while the new practice bills for the delivery and postpartum services.
The Documentation That Supports Global OB Billing
Accurate documentation is essential for successful global OB billing. It not only supports the care provided but also helps practices meet payer requirements during audits.
Initial Antepartum Visit Documentation
The first prenatal visit should establish the expected delivery date, document the patient’s complete obstetric history, confirm the pregnancy, and initiate the global OB billing episode. This visit lays the foundation for the entire course of care.
Ongoing Antepartum Visit Documentation
Each prenatal visit should include key clinical details such as gestational age, fetal heart rate, fundal height, blood pressure, weight, patient concerns, and the provider’s assessment. Consistent documentation helps demonstrate the medical necessity of ongoing care.
Delivery Documentation
The delivery record should clearly document the method of delivery, labor progression, any complications, the newborn’s condition, and the physician’s involvement in the delivery. Complete delivery notes are especially important for supporting reimbursement and reducing audit risk.
Complication Documentation
When pregnancy-related complications require services outside the global package, the documentation must clearly show that the condition required separate evaluation and management beyond routine obstetric care. Without proper support, payers may deny the additional services and bundle them into the global fee.
Postpartum Visit Documentation
The postpartum note should document the patient’s recovery, any complications, contraception counseling, and plans for future gynecological care. Thorough documentation helps support the completion of the global OB episode and demonstrates continuity of care.
The Most Common OB/GYN Global Billing Mistakes
Even experienced practices can make mistakes with global OB billing. The most common errors often lead to denied claims, missed revenue, and compliance risks.
Billing Separately for Services Already Included
Submitting claims for routine prenatal or postpartum visits that are already part of the global package can trigger duplicate billing denials and potential overpayment issues.
Missing Separately Billable Services
Services such as ultrasounds, non-stress tests, and complication management are often overlooked during the global period, resulting in lost reimbursement.
Not Tracking Visit Counts
Without accurate tracking of prenatal visits, practices may miss opportunities to bill separately when a patient exceeds the standard antepartum visit threshold.
Billing the Wrong Global Code
Selecting the wrong global CPT code based on the delivery type can lead to avoidable claim denials and payment delays.
Mishandling Split Care Cases
Patient transfers and shared-care arrangements require clear billing procedures. Without them, practices risk duplicate billing or missed charges.
Assuming All Complications Are Included
Many pregnancy complications qualify for separate reimbursement. Failing to bill for these services can result in significant revenue loss that often goes unnoticed.
Building a Global OB Billing Workflow That Works
Successful OB practices rely on strong processes rather than guesswork. Every new OB patient should be identified and tracked as a global billing patient from the start.
Implementing visit tracking, delivery checklists, and documentation protocols can help ensure that global services and separately billable services are captured correctly. Clinical staff should also document complications and non-routine services clearly so the billing team can identify additional reimbursement opportunities.
Regular audits of global OB claims can help uncover missed charges, coding errors, and workflow gaps before they become larger revenue cycle problems.
The Takeaway
OB/GYN global billing becomes much easier to manage when practices clearly understand what is included in the package and what can be billed separately. Success depends on accurate documentation, consistent workflows, and a billing team that can identify both bundled and non-bundled services throughout the pregnancy journey.
Unfortunately, many revenue losses related to global OB billing go unnoticed. Missed ultrasounds, overlooked complication management, incorrect global codes, and improperly handled split-care cases often do not generate denials. Instead, the revenue is simply never billed or collected.
That’s why regular billing reviews and strong internal processes are essential for protecting practice revenue and maintaining compliance.
GoSourceMD helps OB/GYN practices optimize global billing through specialized support for global package management, split-care billing, documentation review, and identification of separately billable services. The goal is simple: ensure your practice captures the reimbursement it has earned at every stage of patient care.
FAQs
Q. When should I bill separately instead of using the global OB package?
Separate billing may be appropriate when a patient transfers care during pregnancy, develops complications that require additional management, exceeds the standard antepartum visit count, or receives services such as ultrasounds, diagnostic testing, or fetal monitoring that are not included in the global package.
Q. What happens if a patient has a cesarean after planning a vaginal delivery?
The appropriate CPT code depends on the clinical circumstances and whether there was a prior cesarean delivery. Coding should reflect the actual delivery performed and any applicable global or delivery-only billing guidelines.
Q. How do I handle global OB billing when a patient changes insurance during pregnancy?
When insurance changes during pregnancy, services are generally billed to the insurer that provided coverage at the time the services were delivered. Accurate documentation of coverage dates and services rendered is critical for proper reimbursement.
Q. Can I bill for a prenatal visit if the patient comes in for a non-routine concern?
It depends on the reason for the visit. Routine prenatal care is included in the global package. However, visits focused on evaluating and managing a distinct pregnancy complication may qualify for separate reimbursement when properly documented.
Q. What is the difference between CPT 59425 and 59426?
Both codes are used for antepartum care only when the provider does not perform the delivery. CPT 59425 is used for four to six prenatal visits, while CPT 59426 is used for seven or more prenatal visits. These codes are commonly used in transfer-of-care and split-care situations.