Global OB Billing Explained: CPT 59400, 59510, 59610, 59618 and the Coming Unbundling Shift

Global obstetric billing is the largest revenue line item in any OB/GYN practice — and one of the most consistently miscoded. A single global package can pay $3,000–$5,500 depending on payer, delivery type, and geography. Multiply that across 200–800 deliveries per year and a single misapplied bundling rule can quietly cost a practice six figures annually.

The challenge in 2026: the global obstetric package is in transition. The next CPT cycle is expected to unbundle major portions of the global codes, and several major commercial payers have already updated their global-period policies in anticipation. If your practice is still billing every pregnancy under the same global structure you used in 2022, you’re probably leaving money on the table — and you’re definitely not ready for the upcoming shift.

This guide walks through how AMS Solutions’ AAPC-certified team handles global OB billing today, what the four primary global codes (59400, 59510, 59610, 59618) actually include, the carve-outs that are billable separately, and how to position your practice for the coming unbundling shift.

The Four Global Obstetric Codes

The global OB package is described by four primary codes, organized by delivery type and patient history:

• CPT 59400 — Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy/forceps), and postpartum care
• CPT 59510 — Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
• CPT 59610 — Routine obstetric care including antepartum care, vaginal delivery after previous cesarean (VBAC), and postpartum care
• CPT 59618 — Routine obstetric care including antepartum care, cesarean delivery following attempted VBAC, and postpartum care

Each global code represents a “package” that bundles 13+ antepartum visits, the delivery itself, and 6 weeks of postpartum care. The payer pays one fee for the whole episode, regardless of how many visits the patient actually had.

What’s Included in the Global Package

The global package includes:

• All routine antepartum visits (typically 13: monthly through week 28, every 2 weeks through week 36, weekly thereafter)
• Initial OB physical exam and pregnancy diagnosis
• Routine urinalysis at each visit
• Maternal weight, blood pressure, fetal heart tones, fundal height
• Routine RhoGAM administration (drug billed separately, administration bundled)
• Admission to the hospital
• Delivery (vaginal or cesarean per code selection)
• Episiotomy, forceps, vacuum extraction if performed
• Postpartum care for 6 weeks following delivery

If your practice handled all of these for the patient, you bill the appropriate global code. Period.

What’s NOT Included — Billable Separately

Here’s where revenue gets captured or lost. These services are NOT part of the global package and should be billed separately:

• Initial visit to confirm pregnancy if the patient hadn’t yet been diagnosed (E&M code, before global starts)
• Antepartum-only care (if patient transfers care before delivery)
• Visits for problems unrelated to pregnancy — billed with appropriate E&M and modifier -25 if same day as a global visit
• Visits for high-risk monitoring or complications beyond routine antepartum care — modifier -25 and pregnancy complication codes
• Lab work (CBC, glucose challenge, GBS culture, etc.) — bill labs separately
• Ultrasounds — all OB ultrasounds (76801–76828) bill separately from global
• NSTs, BPPs, and antepartum testing (59025, 76818, etc.) — separately billable
• External cephalic version (59412) — separately billable
• Amniocentesis (59000, 59001), CVS (59015) — separately billable
• Postpartum tubal ligation (58611) — separately billable add-on at delivery
• Postpartum visits beyond 6 weeks for problems unrelated to delivery

The single most-missed billable item: ultrasounds. Many practices bundle their OB ultrasounds into the global thinking it’s “all part of the pregnancy” — it’s not. Three or four ultrasounds per pregnancy, billed separately at ~$200–$400 each, can add $600–$1,600 in additional revenue per global package.

Antepartum-Only Care (When the Global Doesn’t Apply)

When the practice doesn’t handle the complete pregnancy — patient transfers care in or out — you can’t bill the global. Use:

• CPT 59425 — Antepartum care only, 4–6 visits
• CPT 59426 — Antepartum care only, 7 or more visits
• CPT 59409 / 59514 / 59612 / 59620 — Delivery only (when antepartum was elsewhere)
• CPT 59410 / 59515 / 59614 / 59622 — Delivery plus postpartum care (when antepartum was elsewhere)
• CPT 59430 — Postpartum care only

Documentation must clearly support the visit count for antepartum-only codes. Less than 4 visits = bill individual E&M codes, not the antepartum-only package.

The Twin / Multiple Gestation Question

Twin and higher-order gestations create coding complexity that’s payer-specific:

• Some payers accept the global code (59400/59510) + modifier -22 for increased complexity
• Some payers require a second delivery code billed at 50% for the second baby (e.g., 59409 with modifier -51)
• A few payers want each baby billed under separate global codes with modifier -22 on the second

Always confirm payer-specific multiple-gestation policy before billing. Documentation must clearly identify each delivery (vaginal vs. cesarean for each baby) and any additional complexity.

Postpartum Care: 6 Weeks, Not Forever

The global package’s postpartum component covers ONLY the routine 6-week postpartum visit and uncomplicated follow-up within that window. Any of the following moves out of the global:

• Postpartum hemorrhage workup
• Wound complications (cesarean incision infection, breakdown)
• Postpartum depression evaluation and management (now subject to expanded coverage rules)
• IUD insertion or contraception counseling beyond brief routine education
• Issues unrelated to the delivery

Bill these separately with appropriate E&M codes. If documentation supports them on the same date as a routine postpartum visit, use modifier -25.

The Coming Unbundling Shift Transition

The biggest change on the OB billing horizon is the expected unbundling of the global obstetric package. The AMA’s CPT Editorial Panel has signaled support for moving toward separate billing of antepartum visits, delivery, and postpartum care — similar to how non-obstetric care works.

Two early-warning signs that practices should watch:

1. Commercial payer policy changes — several major commercial payers have already updated policies to require itemized antepartum visit documentation (visit count, dates, complexity)
2. Documentation expectations — payers are increasingly auditing global claims for actual visit count and duration, not just the lump-sum charge

Practices that build itemized antepartum documentation NOW will have an easier transition than practices still using lump-sum global notes. AMS Solutions has been advising clients to track antepartum visits individually — when the unbundling drops, the practices we work with will be ready on day one.

Common Global OB Denials

The five denial patterns we see most often (and for parallels in other specialties, see our cardiology denial trends breakdown):

1. Ultrasound bundled into global (CO-97). Ultrasounds were correctly billed separately, but the payer is rejecting them as global-package services. Most easily appealable with documentation; some payers have specific carve-out rules.
2. Antepartum-only code mismatch (CO-N822). 59425 billed when documentation shows 7+ visits (should be 59426), or vice versa.
3. Global billed before delivery date (CO-18). Some payers won’t accept the global until after the delivery date is in the chart.
4. Postpartum visit beyond 6 weeks billed under global (CO-50). Late postpartum follow-ups need separate E&M, not global.
5. Multiple gestation billed without payer-specific modifier (CO-N822). Twin/triplet coding done generically when payer requires specific modifier structure.

How AMS Solutions Handles OB/GYN Global Billing

AMS Solutions has been doing medical billing for OB/GYN practices since 1992. Our team is AAPC-certified, HIPAA-compliant, and submits clean claims within 24 hours, and built bespoke around the specialty mix of each practice we serve. OB/GYN billing — and global obstetric billing specifically — is one of the most technically demanding workflows in healthcare. Generic billing services routinely miss the ultrasound carve-out, the antepartum-only thresholds, and the payer-specific multiple-gestation rules.

When we onboard a new OB/GYN practice, the first thing we do is a free practice audit of the last six months of global OB claims. We map every global to documentation, identify the missed billable add-ons (ultrasounds, NSTs, external versions, postpartum complications), and quantify the recoverable revenue. The recovered revenue typically pays for the engagement many times over in the first quarter.

Frequently Asked Questions

Where we work: AMS Solutions provides OB/GYN medical billing services nationwide, with active client practices including OB/GYN billing services in Texas and OB/GYN billing services in California.