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For obstetrics and gynecology practicesOne Code Has Covered Nine Months of Care. That Is Changing.
Obstetric billing is unlike anything else in medicine: a single global code covering antepartum care, the delivery and postpartum care, submitted long after most of the work was done. It is an arrangement built for administrative simplicity, and it is now being taken apart. A practice that bills through that transition on autopilot will be paid on autopilot.
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Nine Months of Care, One Code.
Antepartum care, the delivery and postpartum care, submitted long after most of the work was done. Administratively simple, commercially unforgiving.
With a Long List of Exclusions.
Ultrasound, amniocentesis, genetic screening, unrelated visits, extra visits caused by high-risk conditions. All payable. All frequently folded in and given away.
And the Longest Receivable Cycle in Medicine.
A coverage change in month five becomes a claims problem in month ten, when the care has already been delivered and nothing can be done about it.
Now the Arrangement Itself Is Being Dismantled.
The stated standard from 2027 is visit-based E/M billing for antepartum care, with a recommended transition date already behind us.
Payer by Payer, At Different Speeds.
Which means one default across all plans is guaranteed to be wrong for some of them, on every pregnancy, until someone checks.
In obstetrics a process error does not cost you a visit. It costs you a pregnancy.
The detail
Everything below is the evidence for what you just read.
What is actually inside the global obstetric package?
The total obstetrical packages, for example CPT 59400 and 59510, include antepartum care, the delivery and postpartum care. They do not include ultrasound, amniocentesis, special screening tests for genetic disorders, visits for conditions unrelated and incidental to the pregnancy, or additional frequent visits caused by high-risk conditions.[1]
That exclusion list is where a large share of separately payable OB revenue lives, and it is the list most often left unbilled, because the practice is thinking in terms of one pregnancy and one code rather than a pregnancy plus everything the package never covered.
The Package, Its Edges, and the Change Coming to It
Everything below is as CMS and ACOG publish it, cited at the foot of this page.[1][2] Commercial payer policies vary and are contractual; what follows describes the published position, not what any individual plan has agreed with your practice.
| Where it bites | What the published rule says |
|---|---|
| What the package includes | The total obstetrical packages, such as CPT 59400 and 59510, include antepartum care, the delivery and postpartum care. |
| What it excludes | Ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions incidental to pregnancy, and additional frequent visits due to high-risk conditions. |
| Where postpartum care ends | After the initial postpartum period, no later than 12 weeks after birth, care should not be covered by the global maternity codes and should be billed using the appropriate E/M or procedure codes. |
| The transition | ACOG recommends that health plans begin transitioning from global obstetric payment to E/M codes (99202 to 99499) for antepartum visits, without limitations or preauthorization requirements, and states this will be the standard beginning in 2027. |
| The recommended timing | ACOG recommends the transition occur no later than 1 September 2026, to avoid undue administrative burden and incorrect billing. |
| The interim codes | Codes 59425 and 59426, for four to six and for seven or more antepartum visits, are available in 2026 and are deleted in 2027. |
The last three rows describe a moving target. A practice billing obstetrics today is operating across a boundary where different payers will move at different times, which means the correct way to bill the same pregnancy depends on the plan and the date.
The Longest Accounts Receivable Cycle in Medicine
A global obstetric claim is submitted after delivery for care that began months earlier. Every eligibility change, every plan switch, every coverage lapse that happened during the pregnancy is already in the past by the time anyone submits anything.
That makes obstetrics uniquely exposed to problems that are unfixable by the time they are discovered. A patient whose coverage changed in month five is a claims problem in month ten, and by then the practice has delivered nine months of care against an arrangement that no longer exists.
Add a transition away from global billing, running at different speeds across different payers, and the practice needs to know not only who the patient is covered by but which billing model that payer is currently operating. Very few practices have a way to answer the second question.
What an OB practice usually tracks
- Estimated due dates and visit schedules.
- Deliveries performed by provider.
- Ultrasounds and screenings ordered.
- Charges posted after delivery.
What it usually does not track
- Coverage changes during the pregnancy, as they happen.
- Which payers have moved off global billing and which have not.
- Which excluded services were performed and never separately billed.
- Which postpartum care fell outside the initial period and was folded in anyway.
Six Ways OB/GYN Revenue Goes Missing
Each of these describes care that was delivered across months. The failure is in how it was accounted for, not in how it was provided.
Excluded services folded into the package
Ultrasound, genetic screening and high-risk visits are outside the global package and are separately payable. Billed as part of the pregnancy, they are simply free.
Coverage that changed in month five
Discovered at submission, months later, when nothing can be done about it. The care was delivered against an arrangement that had already lapsed.
Postpartum care past the initial period
Care after the initial postpartum period, no later than 12 weeks, belongs on E/M or procedure codes. Folded into the global code, it is unpaid work.
Billing one model to a payer using another
During the transition, the same pregnancy is billed differently depending on the plan. A single default across all payers guarantees being wrong for some of them.
Unrelated conditions treated as incidental
Visits for conditions unrelated and incidental to pregnancy are excluded from the package, which means they are payable. Treating them as part of prenatal care gives them away.
Gynecology revenue behind obstetric processes
The gynecology side of the practice runs on ordinary visit and procedure billing, and often inherits workflows designed for a nine-month cycle that does not apply to it.
The practical version of all six: obstetrics concentrates a very long period of care into a small number of claims, so a single process error does not cost one visit. It costs a pregnancy.
Where This Fits Around What You Already Run
An illustration of the general flow for an obstetric practice, not a description of any particular practice or payer policy.
- The pregnancy is confirmedCoverage is verified once, against a plan that may not last the pregnancy.
- Antepartum careMonths of visits, some inside the package and some outside it.
- Excluded services along the wayUltrasound, screening, high-risk visits. Separately payable, frequently not separated.
- DeliveryThe event the whole global arrangement is anchored to.
- The claim is finally submittedFor care that began months ago, against whatever coverage actually applied at the time.
- Root cause, not just reworkWhether this is one pregnancy or a workflow that loses the same excluded services every time.
- The pattern, and the fixWhich payer, which model, which service, consistently.
What Should an OB/GYN Practice Ask a Billing Company?
Nine questions for whoever bills for you now, and for CareVixis. The first three matter more in 2026 than they did in any previous year.
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Which of our payers have moved off global obstetric billing?
If they cannot answer payer by payer, they are applying one default across a transition that is not uniform.
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How do you catch coverage changes during a pregnancy?
Verifying once at confirmation is verifying at the least useful moment. Ask what happens in months three, six and nine.
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Which excluded services do you bill separately?
Ultrasound, amniocentesis, genetic screening, unrelated visits, additional high-risk visits. Ask them to list these without prompting.
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How is postpartum care beyond the initial period handled?
It belongs on E/M or procedure codes. Ask how they identify when the initial period has ended.
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Do you handle the gynecology side differently?
It should be. It is ordinary visit and procedure billing and should not inherit a nine-month workflow.
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Do you perform root cause analysis, as a defined process?
In obstetrics a repeating error is expensive per instance, because each instance is a whole pregnancy.
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Can you work with the systems we already run?
An OB practice should not have to change its EHR to have its coverage watched properly.
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What visibility do we get, and how often?
Specifically: where each active pregnancy stands on coverage, not just what was billed after delivery.
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Is the work performed in the United States?
CareVixis is 100% US-based with zero outsourcing. Ask anyone else the same question and get the answer in writing.
Using OB/GYN? Keep It.
Your EHR, your ultrasound and your scheduling are yours. Nothing on this page requires replacing any of them, and a migration would answer none of the questions above.
Keeping your system is a supported outcome, not a fallback. If you later want to move to the CareVixis platform, that move may be offered at no additional migration charge. Keeping the software you already have carries no monthly software fee from CareVixis.
Keep your systems. Change what gets watched during the pregnancy rather than discovered after it.
Questions OB/GYN Practices Ask
What is included in the global obstetric package?
The total obstetrical packages, such as CPT 59400 and 59510, include antepartum care, the delivery and postpartum care. They do not include ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions incidental to the pregnancy, or additional frequent visits due to high-risk conditions.
Is global obstetric billing going away?
It is being transitioned away from. ACOG recommends that health plans begin moving from global obstetric payment to E/M codes for antepartum visits, without limitations or preauthorization requirements, and states this will be the standard beginning in 2027. ACOG recommends the transition occur no later than 1 September 2026. Individual payers will move at different times, so during the transition the correct way to bill depends on the plan and the date.
What happens to codes 59425 and 59426?
They are available in 2026 for four to six and for seven or more antepartum visits respectively, and they are deleted in 2027. A practice relying on them should know when its own payers stop accepting them.
How long does the global package cover postpartum care?
After the initial postpartum period, no later than 12 weeks after birth, care should not be covered by the global maternity codes and should be billed using the appropriate E/M or procedure codes. Care provided beyond that point and folded into the global code is unpaid work.
Do we have to change our EHR to work with CareVixis?
No. CareVixis can manage the revenue cycle around the systems a practice already uses. If your EHR, ultrasound and scheduling work for your clinicians, keep them. A practice that later wants to consolidate on the CareVixis platform can do that at its own pace.
Keep OB/GYN. Add Revenue Intelligence.
Keep your EHR. Keep your ultrasound. Change what happens during the nine months, so that the claim submitted at the end is billed against the coverage that actually applied.
Free. No obligation. No email required.
Sources
- American College of Obstetricians and Gynecologists, Payment for Obstetric Services. Source of the contents of the total obstetrical packages and the list of services they do not include, of the recommendation that health plans transition from global obstetric payment to E/M codes for antepartum visits as the standard beginning in 2027, of the recommended transition date of no later than 1 September 2026, and of the availability of codes 59425 and 59426 in 2026 and their deletion in 2027. acog.org. Accessed 20 September 2026. A professional association source. ACOG's recommendations to health plans are recommendations; individual payer policy is contractual.
- American College of Obstetricians and Gynecologists, Billing for Care after the Initial Outpatient Postpartum Visit: The Fourth Trimester. Source of the position that after the initial postpartum period, no later than 12 weeks after birth, care should not be covered by the global maternity codes and should be billed using the appropriate E/M or procedure codes. acog.org. Accessed 20 September 2026.
- Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 7 (2026). Federal coding policy for the genitourinary and maternity code ranges referenced above. cms.gov. Accessed 20 September 2026.
CareVixis publishes no denial rate, recovery rate or revenue figure for OB/GYN practices. The obstetric billing transition described above is a published professional recommendation and a stated future standard; when any individual payer actually moves is a matter for that payer's policy and your contract, and establishing where each of your payers currently stands is work, not an assumption.
The CareVixis Model, Applied to Medical Billing for OB/GYN Practices
The six CareVixis pillars stay consistent (Revenue Cycle, Credentialing, Technology, Communications, Operations and Growth) while the workflow adapts to this specialty's documentation, coding, payer and operational requirements. Keep the systems that work for you; CareVixis connects responsibility around them.