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Introduction
OB/GYN billing sits at one of the most complex intersections in medical coding. A single pregnancy can generate dozens of separately billable services — some bundled into the global package, some excluded, some payer-dependent. On the GYN side, procedure coding spans everything from routine Pap smears to laparoscopic hysterectomies, each with its own documentation requirements, modifier rules, and bundling edits.
This guide is built to serve both sides: obstetrics (global package mechanics, delivery codes, high-risk pregnancy, split billing) and gynecology (surgical procedures, preventive visits, diagnostic imaging, lab codes). Whether your team is resolving a denied delivery claim, setting up a prenatal billing workflow, or coding a same-day colposcopy and biopsy, this is your reference.
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Medical Billing
OB/GYN CPT Code Cheat Sheet (Quick Reference)
Global Obstetric Package Codes
| CPT Code | Description | 2026 Medicare (approx.) |
|---|---|---|
| 59400 | Global OB care: antepartum + vaginal delivery + postpartum | ~$2,107 |
| 59510 | Global OB care: antepartum + cesarean delivery + postpartum | ~$2,782 |
| 59610 | Global OB: antepartum + vaginal delivery + postpartum, after prior C-section (VBAC) | ~$2,271 |
| 59618 | Global OB: antepartum + cesarean + postpartum, after attempted VBAC | ~$2,867 |
Delivery-Only Codes (Itemization)
| CPT Code | Description | 2026 Medicare (approx.) |
|---|---|---|
| 59409 | Vaginal delivery only (w/ or w/o episiotomy/forceps) | ~$880 |
| 59410 | Vaginal delivery only + postpartum care | ~$1,133 |
| 59514 | Cesarean delivery only | ~$1,380 |
| 59515 | Cesarean delivery only + postpartum care | ~$1,627 |
| 59612 | Vaginal delivery only, after prior C-section (VBAC) | ~$997 |
| 59614 | Vaginal delivery only + postpartum, after prior C-section | ~$1,253 |
| 59620 | Cesarean delivery only, after attempted VBAC | ~$1,453 |
| 59622 | Cesarean delivery only + postpartum, after attempted VBAC | ~$1,700 |
Antepartum & Postpartum Itemization Codes
| CPT Code | Description |
|---|---|
| 59425 | Antepartum care only, 4–6 visits |
| 59426 | Antepartum care only, 7 or more visits |
| 59430 | Postpartum care only (separate procedure) |
| E/M code | Antepartum care only, 1–3 visits — use appropriate E/M code |
Well-Woman & Preventive Visits
| CPT Code | Description |
|---|---|
| 99384 | Preventive visit, new patient, age 12–17 |
| 99385 | Preventive visit, new patient, age 18–39 |
| 99386 | Preventive visit, new patient, age 40–64 |
| 99387 | Preventive visit, new patient, age 65+ |
| 99394 | Preventive visit, established patient, age 12–17 |
| 99395 | Preventive visit, established patient, age 18–39 |
| 99396 | Preventive visit, established patient, age 40–64 |
| 99397 | Preventive visit, established patient, age 65+ |
Common GYN Surgical Procedures
| CPT Code | Description |
|---|---|
| 58150 | Total abdominal hysterectomy (TAH), uterus <250g |
| 58570 | Laparoscopic hysterectomy, uterus <250g |
| 58120 | Dilation and curettage (D&C), diagnostic/therapeutic |
| 58558 | Hysteroscopy, surgical, with biopsy/polypectomy |
| 58300 | Insertion of IUD |
| 58301 | Removal of IUD |
| 57420 | Colposcopy of entire cervix |
| 57454 | Colposcopy with biopsy(s) of cervix and/or ECC |
| 58353 | Endometrial ablation, thermal |
| 58661 | Laparoscopy, surgical; removal of adnexal structures (tubes or ovaries) |
* Rates are illustrative estimates based on 2026 MPFS conversion factor ($32.35/RVU), non-facility setting. Actual payment varies by geographic locality (GPCI), facility/non-facility setting, and payer contract. Verify via CMS PFS Look-Up.
The Global Obstetrical Package
The Global Obstetrical Package is the foundation of maternity billing. It consolidates routine antepartum care, delivery, and postpartum care into a single bundled payment for uncomplicated pregnancies. As defined by the AMA CPT codebook, the global package covers “uncomplicated maternity cases which include antepartum, delivery, and postpartum care.”
Understanding exactly what is inside and outside this package is essential — billing separately for services already bundled is a compliance violation; failing to bill separately for excluded services is lost revenue.
What Is Included in the Global Package
Antepartum Care (Bundled)
- All routine prenatal visits up to approximately 13 encounters: monthly through 28 weeks, biweekly through 36 weeks, weekly from 36 weeks until delivery
- Initial and subsequent prenatal history and physical examination
- Recording of weight, blood pressure, fundal height, and fetal heart tones
- Routine chemical urinalysis (81000, 81002) — dipstick urinalysis only
- Counseling on exercise, nutrition, breastfeeding, and lactation (Medicaid patients)
Intrapartum / Labor & Delivery (Bundled)
- Hospital admission H&P
- Inpatient E/M services provided within 24 hours of delivery
- Management and fetal monitoring of uncomplicated labor
- IV oxytocin administration/induction (performed by provider, not anesthesiologist)
- Insertion of cervical dilator on the same date as delivery
- Artificial rupture of membranes, catheterization
- Vaginal or cesarean delivery; delivery of placenta
- Simple cerclage removal (not under anesthesia)
Postpartum Care (Bundled)
- Uncomplicated inpatient visits following delivery
- Repair of first- and second-degree lacerations
- Routine outpatient E/M services within 6 weeks of delivery
- Contraception counseling prior to discharge
- Education on breastfeeding, lactation, and basic newborn care
- Uncomplicated treatment of nipple problems/infection
One Code Rules
All services within the global package must be reported under a single CPT code (59400, 59510, 59610, or 59618). Billing separate E/M codes alongside the global package for routine prenatal visits is not appropriate and will be denied by commercial payers.
Many major commercial insurers — including Blue Cross Blue Shield, UnitedHealthcare, and Aetna — reimburse based on global maternity codes when eligibility criteria are met.
Services Bundled Within the Global Obstetrical Package
Understanding exactly what is and is not included in the Global Package is a critical part of maternity obstetrical care medical billing.
Antepartum Care (Included)
- Initial prenatal history and physical examination
- Routine prenatal visits (approximately 13 visits)
- Monitoring of weight, blood pressure, and fetal heart tones
- Routine urinalysis
- Patient education related to pregnancy and breastfeeding
Important: Any unrelated medical visit during the antepartum period must be billed separately. For example, if a patient presents with the flu during a prenatal visit period, a separate E&M code should be used for that encounter.
Intrapartum Care — Labor & Delivery (Included)
- Hospital admission evaluation
- Labor management and fetal monitoring
- Vaginal or cesarean delivery
- Delivery of placenta
- Immediate postpartum stabilization
Postpartum Care (Included)
- Routine inpatient and outpatient postpartum visits
- Basic postpartum recovery care
- Breastfeeding guidance
- Contraception counseling
Services Excluded from the Global Obstetrical Package
| Excluded Service | How to Bill | Notes |
|---|---|---|
| Initial E/M for pregnancy confirmation (if antepartum record not yet initiated) | E/M code + CPT Category II: 0500F; ICD-10: Z32.01 | Typically first 12 weeks before ACOG antepartum note starts |
| Laboratory tests (except routine dipstick urinalysis) | Appropriate lab CPT codes | CBC, GBS, HIV, STI panels, glucose, antibody screens — all separately billable |
| Ultrasounds, NST, biophysical profile | 76801–76819, 59025, 76818 | All ultrasounds after the first may be bundled by some carriers — verify per payer |
| Amniocentesis, amnioinfusion, CVS | 59000 (amniocentesis), 59001, 59012 | Always separately billable |
| External cephalic version | 59412 | Separately billable with appropriate diagnosis |
| Cerclage placement (more than 24 hrs before delivery) | 57700 (cervical cerclage, vaginal) or 59320 | Simple cerclage removal without anesthesia is bundled |
| Inpatient E/M services more than 24 hrs before delivery | Appropriate inpatient E/M codes | When patient is admitted for observation/management well before delivery date |
| Third- and fourth-degree laceration repair at delivery | Report using Modifier 22 on the delivery code | Per ACOG coding guidelines |
| Surgical procedures during pregnancy | Appropriate surgical CPT codes | Appendectomy, cholecystectomy, etc. |
| Conditions unrelated to pregnancy (E/M) | E/M code + Modifier 25 + non-pregnancy ICD-10 | Flu, asthma, UTI, cardiac conditions — document separately |
| Contraceptive insertions (IUD, implant) at delivery | 58300 (IUD), 11981 (implant) | Counseling is bundled; insertion procedure is not |
Documentation must clearly support separate billing for each excluded service.
Delivery CPT Codes: Vaginal, Cesarean & VBAC
The delivery code selected depends on three factors: (1) delivery type — vaginal vs. cesarean; (2) whether the patient has had a prior cesarean (VBAC considerations); and (3) whether antepartum and/or postpartum care are included or billed separately.
| CPT Code | Description | Package Type |
|---|---|---|
| 59400 | Routine OB care: antepartum + vaginal delivery (w/ or w/o episiotomy/forceps) + postpartum | Global Package — Vaginal |
| 59409 | Vaginal delivery only (w/ or w/o episiotomy/forceps) | Itemization |
| 59410 | Vaginal delivery only + postpartum care | Itemization |
| 59430 | Postpartum care only (separate procedure) | Itemization |
| 59510 | Routine OB care: antepartum + cesarean delivery + postpartum | Global Package — C-Section |
| 59514 | Cesarean delivery only | Itemization |
| 59515 | Cesarean delivery only + postpartum care | Itemization |
| 59610 | Routine OB: antepartum + vaginal delivery + postpartum, after previous cesarean (VBAC) | Global Package — VBAC |
| 59612 | Vaginal delivery only, after previous cesarean (VBAC) | Itemization |
| 59614 | Vaginal delivery only + postpartum, after previous cesarean | Itemization |
| 59618 | Routine OB: antepartum + cesarean + postpartum, following attempted vaginal delivery after previous cesarean | Global Package — Failed VBAC |
| 59620 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean | Itemization |
| 59622 | Cesarean delivery only + postpartum, following attempted vaginal delivery after previous cesarean | Itemization |
Delivery Coding Log: Reference Table for Quick Code Selection
Use this structured reference to select the correct delivery code based on your clinical scenario. Designed for fast lookup at the time of coding or charge entry.
| Scenario | Delivery Type | Prior C-Section? | Care Provided By Your Practice | Code to Bill |
|---|---|---|---|---|
| Full-term, uncomplicated vaginal delivery | Vaginal | No | Antepartum + Delivery + Postpartum | 59400 |
| Full-term, uncomplicated C-section | Cesarean | No | Antepartum + Delivery + Postpartum | 59510 |
| Vaginal delivery, previous C-section (VBAC) | Vaginal | Yes | Antepartum + Delivery + Postpartum | 59610 |
| Attempted VBAC → C-section | Cesarean | Yes | Antepartum + Delivery + Postpartum | 59618 |
| Delivery only, no antepartum care | Vaginal | No | Delivery only | 59409 |
| Delivery + postpartum, no antepartum | Vaginal | No | Delivery + Postpartum | 59410 |
| C-section only, no antepartum care | Cesarean | No | Delivery only | 59514 |
| C-section + postpartum, no antepartum | Cesarean | No | Delivery + Postpartum | 59515 |
| Antepartum only (4–6 visits), care transferred | N/A | Either | Antepartum 4–6 visits only | 59425 |
| Antepartum only (7+ visits), care transferred | N/A | Either | Antepartum 7+ visits only | 59426 |
| Antepartum only (1–3 visits) | N/A | Either | 1–3 visits, then care transferred | E/M code |
| Postpartum care only | N/A | Either | Postpartum only | 59430 |
| VBAC delivery only | Vaginal | Yes | Delivery only | 59612 |
| VBAC delivery + postpartum only | Vaginal | Yes | Delivery + Postpartum | 59614 |
| Failed VBAC → C-section, delivery only | Cesarean | Yes | Delivery only | 59620 |
| Failed VBAC → C-section + postpartum | Cesarean | Yes | Delivery + Postpartum | 59622 |
Antepartum & Postpartum Itemization Codes
When a provider does not manage the entire obstetric course, itemization codes capture individual care segments. The number of antepartum visits drives code selection for antepartum-only billing.
| Code | Description | When to Use |
|---|---|---|
| E/M | Antepartum care only, 1–3 visits | Patient seen 1–3 times before transferring care or delivering elsewhere |
| 59425 | Antepartum care only, 4–6 visits | Patient seen 4–6 prenatal visits; delivery by another provider |
| 59426 | Antepartum care only, 7 or more visits | Patient seen 7+ prenatal visits; delivery by another provider |
| 59430 | Postpartum care only (separate procedure) | Patient delivered elsewhere; only postpartum follow-up provided by your practice |
Split Billing: When Obstetric Care Is Shared or Transferred
Split billing occurs whenever the complete global OB package cannot be billed by a single provider or group. This is one of the most common sources of OB billing errors and claim denials. The most frequent scenarios are:
Late Prenatal Entry
Patient begins care after receiving antepartum services elsewhere (e.g., started at another practice at 8 weeks, transfers to yours at 28 weeks). Bill 59425 or 59426 for your antepartum visits only, plus the appropriate delivery code.
Mid-Pregnancy Transfer Out
Patient leaves your practice before delivery (relocation, insurance change, preference). Bill 59425 or 59426 for the visits you provided. Do not bill a delivery code.
Insurance Change
Patient switches from commercial to Medicaid (or vice versa) during pregnancy. Contact both insurers — you may need to bill each separately for the portion of care covered under each plan.
Delivery by Different Provider
Your practice provided antepartum care but a different physician in the call group (different tax ID) performed the delivery. Bill antepartum-only codes; the delivering provider bills the delivery code.
Fewer than 13 Antepartum Visits:
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Medical Billing
High-Risk Pregnancy Billing & ICD-10 Codes
High-risk pregnancies require additional monitoring, more frequent visits, and often co-management by a Maternal-Fetal Medicine (MFM) specialist. These additional services are billed outside the global package.
When Can Extra E/M Codes Be Billed?
Per ACOG guidelines, when a patient is co-managed by both their general OB and an MFM provider, all MFM services are outside the global package. The MFM provider may bill E/M services plus any procedures (ultrasounds, fetal Doppler) with Modifier 25 when appropriate. Verify how your specific payer treats MFM co-management when the MFM is within the same group practice — policies vary.
High-Risk Pregnancy ICD-10-CM Codes
| ICD-10 Code | Description |
|---|---|
| O09.8xx | Supervision of other high-risk pregnancies (use for advanced maternal age, prior pregnancy loss) |
| O09.521 | Supervision of elderly primigravida, first trimester (mother ≥35 years, first pregnancy) |
| O09.523 | Supervision of elderly multigravida (subsequent pregnancy, age ≥35) |
| O10.11x | Pre-existing hypertensive heart disease complicating pregnancy |
| O11.x | Pre-existing hypertension with pre-eclampsia |
| O12.x | Gestational edema and proteinuria without hypertension |
| O14.x | Pre-eclampsia (mild, severe, with hemolysis — specify) |
| O24.01x | Pre-existing type 1 diabetes mellitus in pregnancy |
| O24.11x | Pre-existing type 2 diabetes mellitus in pregnancy |
| O24.4x | Gestational diabetes mellitus |
| O26.61x | Liver and biliary tract disorders in pregnancy |
| O36.5x | Maternal care for known or suspected placental insufficiency |
| O60.x | Preterm labor (with or without delivery — specify) |
| O99.0x | Anemia complicating pregnancy, childbirth, and puerperium |
New ICD-10 Codes (October 2024 Updates) — Effective for 2026 Reporting
| Code | Description |
|---|---|
| E10.A0–E10.A2 | Type 1 diabetes mellitus, presymptomatic (stages 1 and 2) |
| E16.A1–E16.A3 | Hypoglycemia levels 1, 2, and 3 |
| E66.811–E66.813 | Obesity classes 1, 2, and 3 (replaces E66.01 for specificity) |
| Z59.71–Z59.72 | Social determinants of health (SDoH): insufficient health insurance; insufficient welfare support |
Normal Delivery Despite High-Risk Classification:
Obstetric Ultrasound & Fetal Monitoring CPT Codes
Ultrasound procedures are excluded from the global OB package and are always separately billable. Each ultrasound must have a written report with retained images per AMA CPT and documentation requirements.
| CPT Code | Description | Notes |
|---|---|---|
| 76801 | OB ultrasound, transabdominal; first trimester (single or first gestation) | Requires estimated gestational age, embryo/fetal number, cardiac activity |
| 76802 | +Add-on: each additional gestation (with 76801) | For each additional embryo/fetus in first trimester |
| 76805 | OB ultrasound, transabdominal; second or third trimester, single or first gestation | Standard anatomy/fetal survey |
| 76810 | +Add-on: each additional gestation (with 76805) | Multiple gestation follow-up |
| 76811 | Detailed fetal anatomic evaluation, transabdominal; single or first gestation | Level II ultrasound — when standard anatomy survey insufficient |
| 76812 | +Add-on: each additional gestation (with 76811) | — |
| 76813 | Fetal nuchal translucency measurement, first trimester | NT screening for chromosomal abnormalities |
| 76814 | +Add-on: each additional gestation (with 76813) | — |
| 76815 | Limited OB ultrasound (e.g., fetal heartbeat, position, placental location) | Limited study — document reason for limited rather than standard exam |
| 76816 | Follow-up or repeat OB ultrasound study | Subsequent monitoring after initial anatomy survey |
| 76817 | OB ultrasound, transvaginal | First trimester dating, low-lying placenta, cervical length |
| 76818 | Fetal biophysical profile (BPP), with NST | Assesses fetal well-being: tone, movement, breathing, amniotic fluid, NST |
| 76819 | Fetal BPP without NST | Modified BPP — some payers require documentation of reason NST not performed |
| 59025 | Fetal non-stress test (NST) | Electronic monitoring of fetal heart rate; common in third trimester high-risk |
| 59020 | Fetal contraction stress test (CST) with interpretation and report | Excluded from global package — bill separately |
Multiple Gestation Ultrasound Billing
Diagnosis Codes for Deliveries (Z and O Codes)
Every delivery claim must include the appropriate principal diagnosis code and an outcome-of-delivery code. Errors in sequencing are a common trigger for OB claim denials.
| Code | Description | When to Use |
|---|---|---|
| O80 | Encounter for full-term uncomplicated delivery | Normal spontaneous vaginal delivery, single healthy infant, no antepartum or intrapartum complications, no postpartum complications during delivery encounter |
| O82 | Encounter for cesarean delivery without indication | Use only when no other condition is documented as reason for the cesarean |
| Z34.x | Encounter for supervision of normal pregnancy | First-listed code for routine prenatal visits — do not combine with O codes |
| Z37.0 | Single liveborn infant | Always report an outcome-of-delivery code (Z37.-) when delivery occurs |
| Z37.2 | Twins, both liveborn | For twin deliveries where both are live |
| Z37.3 | Twins, one liveborn and one stillborn | — |
| Z3A.xx | Weeks of gestation (Z3A.00–Z3A.49) | Always report alongside delivery and antepartum codes to specify gestational age |
Cesarean Delivery Diagnosis Sequencing Rules
- If the patient was admitted because of a condition that resulted in cesarean (e.g., placenta previa, fetal distress), that condition is the principal diagnosis
- If the patient was admitted for labor and a cesarean became necessary (e.g., failure to progress), the admitting diagnosis is principal; the cesarean indication is secondary
- If multiple conditions prompted the cesarean, sequence the one most related to the delivery as principal diagnosis
- Always include all monitored or treated conditions as additional diagnoses (gestational diabetes, pre-eclampsia, prior C-section, anemia, GBS positive)
Well-Woman & Preventive Visit Codes (GYN)
Annual well-woman examinations are preventive visits billed under E/M preventive codes (99384–99397), not standard problem-focused E/M codes. Code selection depends on patient age and whether the patient is new or established.
| Code | Patient Type | Age Range | Typical Services |
|---|---|---|---|
| 99384 | New patient | 12–17 years | Comprehensive H&P, risk assessment, immunizations, counseling |
| 99385 | New patient | 18–39 years | Pelvic exam, Pap/STI screening, contraception counseling |
| 99386 | New patient | 40–64 years | Breast exam, mammography referral, menopause counseling |
| 99387 | New patient | 65+ years | Osteoporosis screening, cardiovascular risk, comprehensive review |
| 99394 | Established patient | 12–17 years | Annual gynecologic review |
| 99395 | Established patient | 18–39 years | Annual well-woman — most common code for reproductive-age patients |
| 99396 | Established patient | 40–64 years | Annual well-woman — perimenopausal/menopausal |
| 99397 | Established patient | 65+ years | Annual geriatric well-woman |
Well-Woman + Problem Visit Same Day (Modifier 25):
Pap Smear, HPV Testing & GYN Lab Codes
Laboratory and pathology codes for gynecologic preventive and diagnostic testing are billed separately from the office visit. Understanding the distinction between the collection, processing, and interpretation components is essential for complete capture.
Cervical Cytology (Pap Smear)
| Code | Description | Notes |
|---|---|---|
| 88141 | Cervical/vaginal cytology; interpretation by physician | Professional component only |
| 88142 | Cervical/vaginal cytology (ThinPrep), automated screening under physician supervision | Most common liquid-based cytology code |
| 88143 | Cervical/vaginal cytology, automated with manual rescreening | — |
| 88164 | Cytopathology slides, cervical/vaginal; manual screening under physician supervision | Conventional smear |
| G0123 | Screening cervical/vaginal cytology (Medicare preventive benefit) | Use for Medicare patients receiving screening Pap |
| G0124 | Screening cytology, cervical/vaginal, under physician supervision (Medicare) | — |
HPV Testing
| Code | Description |
|---|---|
| 87624 | HPV, low-risk types (types 6, 11, 42, 43, 44) |
| 87625 | HPV, high-risk types (types 16, 18, 31, 33, 45, 52, 58, others) |
| G0476 | Screening cytology smear plus HPV test (Medicare combined screening) |
STI & GYN Lab Panels
| Code | Description |
|---|---|
| 87491 | Chlamydia trachomatis, amplified probe technique |
| 87591 | Neisseria gonorrhoeae, amplified probe technique |
| 87850 | Neisseria gonorrhoeae culture |
| 86592 | Syphilis test, qualitative (RPR/VDRL) |
| 86703 | HIV-1/HIV-2, combination antigen/antibody |
| 81025 | Urine pregnancy test (qualitative) |
| 58100 | Endometrial biopsy without cervical dilation |
| 58110 | Endometrial biopsy, performed with colposcopy |
Preventive Counseling Codes
| Code | Description |
|---|---|
| 99401 | Preventive medicine counseling, approximately 15 minutes (contraception, STI prevention) |
| 99402 | Preventive medicine counseling, approximately 30 minutes |
| 99403 | Preventive medicine counseling, approximately 45 minutes |
| 99404 | Preventive medicine counseling, approximately 60 minutes |
GYN Surgical Procedure Codes
GYN surgical codes require precise selection based on the approach (abdominal, vaginal, laparoscopic), extent of surgery, and any additional procedures performed in the same session. Bundling rules and add-on codes apply frequently in this category.
Endometrial Procedures
| Code | Description | Approach |
|---|---|---|
| 58120 | Dilation and curettage (D&C), diagnostic and/or therapeutic (non-obstetrical) | Transcervical |
| 58353 | Endometrial ablation, thermal (e.g., NovaSure, ThermaChoice) | Transcervical/hysteroscopic |
| 58356 | Endometrial cryoablation with ultrasonic guidance | — |
Hysteroscopy Procedures
| Code | Description |
|---|---|
| 58555 | Hysteroscopy, diagnostic (separate procedure) |
| 58558 | Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C |
| 58559 | Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method) |
| 58560 | Hysteroscopy, surgical; with division or resection of intrauterine septum (any method) |
| 58561 | Hysteroscopy, surgical; with removal of leiomyomata |
| 58562 | Hysteroscopy, surgical; with removal of impacted foreign body |
| 58563 | Hysteroscopy, surgical; with endometrial ablation |
Fallopian Tube & Ovarian Procedures
| Code | Description | Approach |
|---|---|---|
| 58600 | Ligation or transection of fallopian tube(s), abdominal or vaginal approach | Open/vaginal |
| 58661 | Laparoscopy, surgical; with removal of adnexal structures (tube(s) and/or ovary(s)) | Laparoscopic |
| 58700 | Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) | Open |
| 58720 | Salpingo-oophorectomy, complete or partial, unilateral or bilateral | Open |
| 58925 | Ovarian cystectomy, unilateral or bilateral | Open |
| 58940 | Oophorectomy, partial or total, unilateral or bilateral | Open |
Fibroid & Myomectomy Codes
| Code | Description | Approach |
|---|---|---|
| 58140 | Myomectomy, abdominal; 1–4 intramural myomas with total weight <250g | Open abdominal |
| 58145 | Myomectomy, vaginal approach | Vaginal |
| 58545 | Laparoscopic myomectomy, intramural or subserosal; 1–4 myomas, total weight <250g or maximum 5 cm | Laparoscopic |
| 58546 | Laparoscopic myomectomy, 5 or more myomas or total weight ≥250g | Laparoscopic |
Colposcopy & Cervical Procedure Codes
Colposcopy procedures are commonly triggered by abnormal Pap smear results (ASC-US, LSIL, HSIL) or positive high-risk HPV tests. Code selection depends on what was examined (cervix, vagina, vulva) and what additional procedures were performed (biopsy, ECC, LEEP).
| Code | Description | Add-On Procedures |
|---|---|---|
| 57420 | Colposcopy of entire vagina with cervix, if applicable | — |
| 57421 | Colposcopy of entire vagina with cervix; with biopsy(s) of vagina/cervix | — |
| 57452 | Colposcopy of cervix, including upper/adjacent vagina | — |
| 57454 | Colposcopy, with biopsy(s) of cervix and/or endocervical curettage (ECC) | Includes ECC when performed |
| 57455 | Colposcopy with biopsy(s) of cervix | — |
| 57456 | Colposcopy with ECC only (no biopsy) | — |
| 57460 | Colposcopy with loop electrode biopsy(s) of cervix | LLETZ/LEEP biopsy |
| 57461 | Colposcopy with loop electrode conization (LEEP) | Cone biopsy via LEEP |
| 57500 | Cervical biopsy, single or multiple, or local excision of lesion; without colposcopy | Without colposcopic guidance |
| 57520 | Conization of cervix with or without fulguration, curettage, and repair (cold knife or laser) | Cold knife cone biopsy |
Same-Day Colposcopy + E/M Billing:
Hysterectomy CPT Codes
Hysterectomy coding depends on three factors: (1) surgical approach — abdominal, vaginal, or laparoscopic; (2) extent of resection — total vs. supracervical; and (3) uterine weight (above or below 250g), which affects some laparoscopic code thresholds.
Abdominal Hysterectomy (58150–58240)
| Code | Description |
|---|---|
| 58150 | Total abdominal hysterectomy (TAH), with or without removal of tube(s), with or without removal of ovary(s) |
| 58152 | TAH with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz) |
| 58180 | Supracervical abdominal hysterectomy (subtotal), with or without removal of tube(s), with or without removal of ovary(s) |
| 58200 | Total abdominal hysterectomy including partial vaginectomy, for malignancy |
| 58240 | Pelvic exenteration for gynecologic malignancy, with total excision of organs |
Vaginal Hysterectomy (58260–58294)
| Code | Description |
|---|---|
| 58260 | Vaginal hysterectomy, for uterus 250g or less |
| 58262 | Vaginal hysterectomy, ≤250g; with removal of tube(s) and/or ovary(s) |
| 58275 | Vaginal hysterectomy, with total or partial colpectomy |
| 58290 | Vaginal hysterectomy, uterus greater than 250g |
Laparoscopic Hysterectomy (58541–58579)
| Code | Description |
|---|---|
| 58541 | Laparoscopic supracervical hysterectomy (LSH), uterus ≤250g |
| 58542 | LSH, ≤250g; with removal of tube(s) and/or ovary(s) |
| 58543 | LSH, uterus >250g |
| 58544 | LSH, >250g; with removal of tube(s) and/or ovary(s) |
| 58570 | Total laparoscopic hysterectomy (TLH), uterus ≤250g |
| 58571 | TLH, ≤250g; with removal of tube(s) and/or ovary(s) |
| 58572 | TLH, uterus >250g |
| 58573 | TLH, >250g; with removal of tube(s) and/or ovary(s) |
Contraception & IUD Procedure Codes
| Code | Description | Notes |
|---|---|---|
| 58300 | Insertion of intrauterine device (IUD) | Bill for the procedure; drug cost (device) billed separately with J-code or supply code |
| 58301 | Removal of intrauterine device (IUD) | Can be billed with 58300 if removal + reinsertion occur same day (use Modifier 51) |
| 11981 | Insertion, non-biodegradable drug delivery implant (etonogestrel implant, e.g., Nexplanon) | — |
| 11982 | Removal, non-biodegradable drug delivery implant | — |
| 11983 | Removal with reinsertion, non-biodegradable drug delivery implant | One code covers both removal and replacement |
| J7296–J7302 | IUD device HCPCS J-codes (Mirena, Kyleena, Liletta, Skyla, Paragard) | Bill separately from the insertion CPT code |
IUD at Delivery
GYN Radiology & Imaging Codes
| Code | Description | Common Indications |
|---|---|---|
| 76830 | Ultrasound, transvaginal (non-obstetric) | Ovarian cysts, uterine fibroids, endometrial thickness, ectopic pregnancy |
| 76856 | Ultrasound, pelvic (non-obstetric); complete | Pelvic masses, adnexal pathology |
| 76857 | Ultrasound, pelvic (non-obstetric); limited or follow-up | Follow-up of known finding |
| 74740 | Hysterosalpingography, radiological supervision and interpretation | Infertility workup — tubal patency assessment |
| 72195 | MRI, pelvis; without contrast | Endometriosis staging, ovarian cancer evaluation |
| 72197 | MRI, pelvis; without and with contrast | Uterine fibroids, pelvic floor disorders |
| 72193 | CT, pelvis; without contrast | Pelvic mass initial evaluation, staging |
| 77057 | Screening mammography, bilateral | Annual breast cancer screening |
| 77063 | Screening digital breast tomosynthesis (DBT), bilateral | 3D mammography; preferred in high-density breasts |
Modifiers in OB/GYN Billing
OB/GYN has one of the most modifier-intensive billing environments in medicine. The following modifiers are most frequently used — and most frequently misapplied.
| Modifier | Meaning | OB/GYN Application |
|---|---|---|
| 22 | Increased procedural services | Third/fourth degree laceration repair at delivery; complex cesarean. Attach operative report and documentation of increased complexity. Expect payer review — include a cover letter explaining the additional work. |
| 24 | Unrelated E/M during postoperative period | E/M visit during the postpartum global period (6 weeks post-delivery) for a condition unrelated to the delivery (e.g., UTI, hypertension flare, other medical issue). |
| 25 | Significant, separately identifiable E/M on same day as procedure | Most common in OB/GYN: annual exam + colposcopy; prenatal visit + unrelated condition; IUD insertion + E/M. Document the separate decision-making clearly. |
| 51 | Multiple procedures | When multiple surgical procedures are performed in the same session (e.g., hysterectomy + salpingo-oophorectomy). Apply to secondary procedure(s). Some payers do not recognize 51 — use billing system flags. |
| 57 | Decision for surgery | E/M service on the day of or day before a major procedure where the decision for surgery was made. Used in place of Modifier 25 for major surgical procedures (global period of 90 days). |
| 59 | Distinct procedural service | When two procedures normally bundled are separately performed and medically necessary (e.g., cervical biopsy + endometrial biopsy same day). Always support with documentation. |
| 78 | Unplanned return to OR for related procedure during postoperative period | Re-exploration for hemorrhage after cesarean; return to OR for wound dehiscence after hysterectomy. |
| 80 | Assistant surgeon | When a second surgeon assists with a complex procedure (e.g., complicated hysterectomy, cesarean hysterectomy). |
| XE | Separate encounter (subset of 59) | Use only when services are distinct because they occurred during separate encounters on the same DOS. Do not use interchangeably with 59. |
| XS | Separate structure (subset of 59) | When procedures are distinct because performed on separate anatomical structures. |
| XU | Unusual non-overlapping service (subset of 59) | Service that does not overlap usual components of the main service. Often preferred over 59 by Medicare. |
State & Medicaid Modifier Rules:
Multiple Gestation & Twin Delivery Coding
Twin and multiple-gestation deliveries require careful coding to avoid denials. The ACOG provides specific guidance on how to report twin deliveries based on the combination of delivery types for each fetus.
| Twin Scenario | Twin A Code | Twin B Code |
|---|---|---|
| Both vaginal, no prior C-section, global care | 59400 | 59400-59 |
| Both cesarean, global care | 59510 (Twin A) | 59510 (Twin B) |
| Both vaginal, prior C-section (VBAC), global care | 59610 | 59612-59 |
| Twin A vaginal, Twin B cesarean (combined delivery) | 59409-51 | 59514 |
| VBAC delivery + cesarean (failed VBAC second twin) | 59612-51 | 59618 |
Complex Cesarean with Twins:
2026 MPFS Updates Affecting OB/GYN
The 2026 Medicare Physician Fee Schedule (MPFS), finalized in November 2025, includes updates relevant to OB/GYN practices. Note that obstetric global package codes are primarily commercial payer claims — Medicare does not typically cover prenatal care for most patients — but the MPFS affects GYN procedure reimbursement directly.
| Update | Impact on OB/GYN |
|---|---|
| New ICD-10-CM codes (October 2024 cycle) | New diabetes specificity codes (E10.A0–A2), hypoglycemia levels (E16.A1–A3), obesity classification (E66.811–813), SDoH codes (Z59.71–Z59.72) — all relevant to high-risk OB billing |
| Preventive service coverage expansion | CMS and USPSTF recommendations affect which preventive GYN services are covered at 100% under ACA-compliant plans — verify annual well-woman and cervical cancer screening coverage requirements with your payer mix |
| Telehealth permanence for behavioral health | Perinatal mental health services (postpartum depression, anxiety) may be billed via telehealth on a permanent basis following PHE extension provisions |
| NCCI edits update (quarterly) | Review bundling edits for hysteroscopy procedures and GYN surgical add-on codes — NCCI updates quarterly and new edits can unexpectedly bundle previously separately-billable services |
| 3D mammography (77063) coverage | Digital breast tomosynthesis remains covered for annual screening; payer-specific cost-sharing rules vary — verify patient benefit status |
Telehealth in OB/GYN Practice
Several OB/GYN services that expanded during the COVID-19 PHE have been permanently extended for telehealth billing. OB/GYN practices have a significant opportunity to serve patients with prenatal check-ins, postpartum mental health support, and GYN follow-up via telehealth.
| Service | Code(s) | Telehealth Status (2026) |
|---|---|---|
| Office E/M visits (established) | 99212–99215 | Permanently covered via audio-video |
| Office E/M visits (new patient) | 99202–99205 | Covered; some MACs have geographic restrictions — verify locally |
| Postpartum depression screening | 96127 (brief behavioral/emotional assessment) | Covered via telehealth when appropriate |
| Behavioral health integration services | 99484, 99492–99494 | Permanently extended post-PHE |
| Prenatal antepartum check-ins (low-risk) | 99212–99214 | Some payers accept telehealth for routine prenatal visits; verify per payer |
| Contraception counseling | 99401–99404 | Covered by many commercial payers via telehealth |
Audio-Only Telehealth:
Telehealth in OB/GYN Practice
Several OB/GYN services that expanded during the COVID-19 PHE have been permanently extended for telehealth billing. OB/GYN practices have a significant opportunity to serve patients with prenatal check-ins, postpartum mental health support, and GYN follow-up via telehealth.
| Service | Code(s) | Telehealth Status (2026) |
|---|---|---|
| Office E/M visits (established) | 99212–99215 | Permanently covered via audio-video |
| Office E/M visits (new patient) | 99202–99205 | Covered; some MACs have geographic restrictions — verify locally |
| Postpartum depression screening | 96127 (brief behavioral/emotional assessment) | Covered via telehealth when appropriate |
| Behavioral health integration services | 99484, 99492–99494 | Permanently extended post-PHE |
| Prenatal antepartum check-ins (low-risk) | 99212–99214 | Some payers accept telehealth for routine prenatal visits; verify per payer |
| Contraception counseling | 99401–99404 | Covered by many commercial payers via telehealth |
MIPS Quality Reporting for OB/GYN Practices
OB/GYN physicians participating in Medicare who meet the MIPS participation threshold must report quality measures to avoid negative payment adjustments (up to -9% in 2026). The following measures are particularly relevant to OB/GYN practice.
| Measure # | Description | Relevance |
|---|---|---|
| 317 | Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up | Critical for prenatal and well-woman visits |
| 336 | Maternity Care: Elective Delivery or Early Induction Without Medical Indication at ≥37 and <39 Weeks | Core OB quality measure — document medical indication for early delivery |
| 113 | Preventive Care: Cervical Cancer Screening | Well-woman visits — document Pap and HPV screening performed or patient declined |
| 226 | Preventive Care and Screening: Tobacco Use — Screening and Cessation Intervention | Critical in prenatal care — smoking cessation counseling is a documented quality measure |
| 316 | Preventive Care: Screening for Depression and Follow-Up Plan | Postpartum depression is a major patient safety issue — document screening with validated tool (PHQ-9, EPDS) |
| 050 | Urinary Incontinence: Assessment of Presence or Absence | Relevant for GYN patients, particularly postpartum |
Reference: CMS QPP Quality Measures Library
Common OB/GYN Denial Reasons & Prevention
| Denial Type | Common Cause | Prevention Strategy |
|---|---|---|
| Global package billed when care was split | Billing 59400 when the patient transferred providers mid-pregnancy or the delivering provider was not part of the same group | Always verify: same tax ID / same EHR record for the group. If split care, use itemization codes and contact insurer in advance. |
| Ultrasound bundled into global — denied as duplicate | Some payers bundle the first or subsequent ultrasounds into the global package payment. Separately billing them triggers a denial. | Verify per-payer ultrasound coverage policy for OB patients. Many commercial payers cover all ultrasounds separately; some do not after the initial anatomy scan. |
| E/M during global period denied (Modifier 25/24 missing) | Billing an E/M code during the global antepartum or postpartum period without the correct modifier and documentation | Use Modifier 25 for unrelated conditions during antepartum visits; use Modifier 24 during the postpartum period. Document clearly that the E/M was separate from routine prenatal care. |
| Delivery code + antepartum code on same claim | Billing a global package code (59400) and an antepartum itemization code (59425) on the same claim for the same pregnancy | Never mix global and itemization codes for the same episode of care. If billing split care, use only itemization codes. |
| Colposcopy with E/M denied — Modifier 25 missing | Physician performs colposcopy and bills both a procedure code and a problem-focused E/M without Modifier 25 on the E/M | Append Modifier 25 to the E/M code and document a distinct clinical decision in the chart note separate from the indication for the colposcopy. |
| Hysteroscopy bundling denial | Billing diagnostic hysteroscopy (58555) alongside a surgical hysteroscopy (58558–58563) on the same day | Diagnostic hysteroscopy is a “separate procedure” — it is included in the surgical hysteroscopy codes and should not be billed separately on the same date. |
| Medicaid non-standard delivery code denial | Using standard commercial OB codes for Medicaid deliveries in states that use non-standard codes | Download the current OB billing guidelines from your specific state Medicaid carrier annually. Several states require different delivery codes or encounter billing for HMO plans. |
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This guide reflects Neolytix’s expertise in healthcare revenue cycle management and is intended for educational purposes only. It does not constitute legal or compliance advice. CPT codes and reimbursement rates are periodically updated by the AMA and CMS. Always verify current codes and rates using the CMS Physician Fee Schedule Lookup Tool and the AMA CPT code database.
Frequently Asked Questions
What is the Global Obstetrical Package and what does it include?
The Global Obstetrical Package bundles routine antepartum care (approximately 13 prenatal visits), labor and delivery management, and postpartum care into a single reimbursement for uncomplicated pregnancies. Global billing applies when all three phases of care are provided by the same provider or group practice under the same tax ID.
When should individual OB codes be used instead of global package codes?
Individual codes are used when a provider does not deliver all three phases of care — for example, in transfer of care, late prenatal entry, or when delivery is performed by a different provider. Split billing codes (59425, 59426, 59409, 59514, 59430) are used to bill only the services actually rendered.
What services are excluded from the Global Obstetrical Package?
Services always billed separately include pregnancy confirmation visits, non-routine laboratory tests, amniocentesis, CVS, external cephalic version, cerclage, management of unrelated medical conditions, third- or fourth-degree laceration repair, and contraceptive insertions. Documentation must clearly support separate billing for each.
How should a high-risk pregnancy be coded at delivery if no complications occur?
Per ICD-10-CM guidelines, when a patient with a high-risk designation delivers without complications, the delivery must be coded as a normal delivery (O80) — not as a high-risk encounter. The high-risk supervision code used during antepartum care does not carry over to the delivery if the delivery itself is uncomplicated.
What is the correct use of Modifier 22 in maternity billing?
Modifier 22 is appended to indicate that the service required substantially more work than typically described by the CPT code — for example, a cesarean delivery complicated by severe adhesions or other significant intraoperative findings. An operative report clearly documenting the increased complexity must support its use.
Sources & References
- AMA CPT Current Procedural Terminology Codebook 2026 — American Medical Association
- ACOG Committee Opinion: Coding in Obstetrics and Gynecology — American College of Obstetricians and Gynecologists
- CMS Physician Fee Schedule Look-Up Tool — Centers for Medicare & Medicaid Services
- Federal Register: CY 2026 Medicare Physician Fee Schedule Final Rule
- CMS National Correct Coding Initiative (NCCI) Edits
- CMS Local Coverage Determination (LCD) Database
- U.S. Preventive Services Task Force (USPSTF) Recommendations — preventive GYN services coverage
- CMS QPP MIPS Quality Measures Library — Quality Payment Program
- CMS 2026 Medicare Telehealth Services List
- CMS ICD-10-CM Official Guidelines for Coding and Reporting FY 2026
- OIG Fraud Prevention & Compliance Resources
- Non-Stress Test (NST) — StatPearls, NCBI
