Specialized Billing for Women’s Health Practices Nationwide

“We take care of you, so you can take care of your patients.”

For more than three decades, AMS Solutions has handled medical billing for OB/GYN and women’s health practices across the United States. We’re U.S.-based, in-house, AAPC-certified, and HIPAA-compliant — and we know OB/GYN coding inside and out, from the global obstetric package to well-woman visits to the upcoming 2027 transition away from bundled maternity codes.

This page walks through how AMS handles OB/GYN billing, the codes and modifiers we work with daily, and what to expect when you partner with us.

A Bespoke Team for Your OB/GYN Practice

Every AMS client is assigned a dedicated billing team led by an Account Manager you can reach directly — no overseas call centers, no phone trees, no handoffs between strangers. Your team is built specifically for OB/GYN coding nuances and the EMR/EHR you already use (Epic, eClinicalWorks, athenahealth, Practice Fusion, and others).

• Account Manager — your single point of contact, hands-on with daily RCM, charge capture, rejection resolution, and denial work.
• Billing Specialists — focused on OB/GYN-specific claim submission, payer rules, and global-package tracking.
• Director of Operations — workflow design, SOP development, audit.
• Credentialing Team — provider enrollment, revalidations, payer maintenance.

OB/GYN Billing Expertise

OB/GYN is one of the most complex specialties in medical billing because it bundles months of care into single global codes, requires careful split-billing when care transfers between providers, and is subject to a major 2027 coding overhaul. We’ve built specific operational depth in every part of it.

The Global Obstetric Package

When a single provider or group manages a complete pregnancy, billing rolls up into one global code:

• CPT 59400 — Vaginal delivery, antepartum care, postpartum care
• CPT 59510 — Cesarean delivery, antepartum care, postpartum care
• CPT 59610 — VBAC delivery (after previous cesarean), antepartum care, postpartum care
• CPT 59618 — Cesarean after attempted VBAC, antepartum care, postpartum care

Each global code bundles approximately 13 prenatal visits, the delivery, and routine postpartum follow-up through 6 weeks.

Split Billing (When the Global Doesn’t Apply)

The global package only applies when a single provider or group manages the entire pregnancy. Real life rarely cooperates. We routinely handle split billing for transfer of care mid-pregnancy, late prenatal entry, insurance change mid-pregnancy, and deliveries performed by a different provider than antepartum care. The codes:

• CPT 59425 — Antepartum care, 4–6 visits
• CPT 59426 — Antepartum care, 7+ visits
• CPT 59430 — Postpartum care only
• CPT 59409 — Vaginal delivery only (no antepartum or postpartum)
• CPT 59514 — Cesarean delivery only (no antepartum or postpartum)

Services Excluded from the Global Package

Services that should always be billed separately — and that practices often forget to capture:

• Initial pregnancy confirmation visits
• Non-routine laboratory tests
• Amniocentesis
• Chorionic villus sampling (CVS)
• External cephalic version (ECV)
• Cervical cerclage
• Management of unrelated medical conditions
• Third- or fourth-degree laceration repair
• Contraceptive insertion (e.g., IUD placement post-delivery)

Well-Woman Visits & Preventive Care

Annual gynecological exams, Pap smears, breast exams, and contraceptive management each have specific coding rules under preventive vs. problem-focused E&M. Modifier -25 is required when a problem-focused E&M is performed at the same visit as a preventive service. Our team tracks these distinctions on every claim.

IUD Insertion and Contraceptive Management

IUD placement (CPT 58300), IUD removal (CPT 58301), Implanon and Nexplanon insertion and removal, and contraceptive counseling each have payer-specific rules and modifier requirements. We bill the device and the procedure separately when the payer requires it.

The 2027 Maternity Coding Transition

In 2027, CMS and AMA are phasing out the bundled global-OB codes in favor of discrete service-based codes — meaning each prenatal visit, delivery component, and postpartum service will be billed individually. This is the biggest OB/GYN coding shift in decades, and practices that aren’t ready will see revenue disruption in Q1 2027. We’re already preparing client workflows for the transition.

2026 OB/GYN CPT Coding Updates

The AMA releases CPT code updates each year, and 2026 brings several changes relevant to OB/GYN practices. The revised E/M guidelines continue their trajectory toward medical-decision-making (MDM) and time-based coding, including new telehealth codes for postpartum follow-up visits. Modifier 25 guidelines have been tightened — payers now require explicit documentation of a separately identifiable problem-focused service when billed with a preventive visit. MIPS has added new OB/GYN-specific quality measures around prenatal HIV screening, postpartum depression follow-up, and cervical cancer screening timeliness. AMS tracks every coding change through our AAPC-certified team and adjusts your charge capture workflows proactively, so your practice never falls behind on compliance or reimbursement.

Preventive Service Billing Challenges in OB/GYN

Preventive service billing in OB/GYN is a persistent denial trigger because the distinction between preventive and problem-focused visits is nuanced. Well-woman visits using preventive medicine codes (99381–99397) cover the annual exam, Pap smear, and breast exam — but if the same visit addresses a separate complaint like pelvic pain or abnormal bleeding, modifier 25 is required on the problem-focused E/M code. Medicare’s initial preventive physical exam (IPPE or “Welcome to Medicare”) has different coverage rules than a standard annual visit, and many commercial plans define their own preventive benefit. HPV vaccination administration coding varies significantly by payer; some require the vaccine code alongside a separate administration fee code. Your practice can reduce these denials with specialty-specific workflows. AMS’s credentialing team ensures your payer contracts accurately reflect your preventive service codes.

Global Maternity Billing: Getting the Full Package Right

Even experienced OB/GYN billers leave revenue on the table under the global package. Each global code bundles approximately 13 antepartum visits, the delivery, and 6 weeks of postpartum care — but documentation gaps in visit counting are the most common reason for payer takebacks. Separately billable services during the global period include amniocentesis (CPT 59000), chorionic villus sampling (CVS, CPT 59015), external cephalic version (ECV, CPT 59412), cervical cerclage (CPT 59320), and third- or fourth-degree laceration repair. Payer-specific global definitions vary: Medicare follows the surgical package concept, while many commercial plans define global by the CPT code book. Using modifier 59 appropriately during the global period prevents denied bundles on legitimate separate services. Full RCM services from AMS ensure every billable event is captured.

Maximizing Reimbursement Under the Global Package

To maximize reimbursement under the global package, document every antepartum encounter with date, duration, and medical necessity. Track your visit count against the 13-visit standard — if a patient requires more than 13 visits, the additional visits may be separately billable with modifier 25 and the appropriate E/M code. The 2027 unbundling of global maternity codes will fundamentally change this landscape: every component will be billed individually, which means practices that already have strong visit-level documentation will transition smoothly. AMS runs monthly documentation audits to identify missed billables before claims go out.

A Proven Process

• Claims submitted within 24 hours of creation
• Checked, scrubbed, and submitted daily
• Denials and rejections handled immediately
• ERAs/EOBs posted upon receipt
• Monthly custom financial health report
• Regular meetings to refine workflows

Security & Compliance

• HIPAA compliant. Every client practice signs a Business Associate Agreement (BAA). Safeguards meet HIPAA requirements.
• Secure systems. Encrypted data and secure networks for every workflow involving patient information.
• Role-based access. Sensitive information is controlled, audit-logged, and limited to team members who need it.
• AAPC-certified staff. Our billers and coders hold AAPC credentials (CPC, CPB), and continuing education keeps them current as payer policy evolves.

How Even a Small Improvement Makes a Big Difference

A practice with $250,000 in monthly collections and an 8% denial rate is leaving roughly $20,000 on the table every month. Cut that denial rate to 4% — realistic when claims are scrubbed properly and denials are worked immediately — and you recover roughly $10,000 a month. That’s $120,000 a year in revenue that was already yours.

Example for illustration purposes only. Actual results vary by specialty, payer mix, volume, workflow, and current billing performance.

Get a Free OB/GYN Billing Audit

If you’re considering switching billing partners — or moving from in-house to outsourced for the first time — we offer a free practice audit. Within two weeks you’ll receive a written report covering your clean claim rate, denial breakdown by category, days in AR by payer, and the specific revenue we believe is recoverable. The audit is yours whether you hire us or not.

Related Specialty Billing Services

AMS Solutions provides specialty-specific medical billing across women’s health and related specialty practices. Explore our other specialty billing pages:

• Cardiology Medical Billing — cardiac cath, PCI, echo, EP, and the prior auth and modifier handling that drives roughly 10-15% of cardiology denials.
• Neurology Medical Billing — EMG/NCS pro-tech splits, EEG, chronic migraine Botox (J0585), and the highest initial denial rate in medicine at 35%.
• Family Practice Medical Billing — E/M coding, Annual Wellness Visits, Chronic Care Management, vaccine administration, and the diverse primary care payer mix.
• All Specialties We Serve — full list of specialty practices AMS supports nationwide.