OB/GYN Global Package Billing Explained with Examples

OB/GYN Global Package Billing Explained with Examples

Billing in obstetrics and gynecology (OB/GYN) is one of the most intricate areas of medical billing. Unlike other specialties where each patient encounter or procedure is billed individually, OB/GYN often relies on global maternity packages. These packages bundle a wide range of services, from prenatal visits to delivery and postpartum care, into one payment.
On the surface, this may seem straightforward, but in reality, it creates confusion for many practices. Providers must clearly outline what services are included in the global package, which services require specialized billing, and how payer rules can differ. A small mistake in coding or documentation can lead to claim denials, underpayments, or compliance issues.

Understanding OB/GYN global package billing is essential for protecting revenue and keeping a practice financially stable. In this blog, we’ll break down the inclusions, exclusions, common coding examples, challenges, and best practices. Finally, we’ll also discuss how specialized billing services like MaxRemind can help practices manage these complexities with ease.

What is OB/GYN Global Package Billing?

The OB global package refers to a payment model where a payer reimburses the provider a single fee for the entire episode of maternity care, rather than paying separately for each visit or service. This bundled payment typically includes prenatal care, delivery, and postpartum care.

The intent behind global billing is to simplify reimbursement for insurers. Instead of processing dozens of separate claims, they process one comprehensive payment. However, this simplification for payers translates into added complexity for providers. Practices must track every single service, determine whether it falls under the global package, and submit claims correctly.

It is also important to note that not every insurance company follows the same rules. While CPT codes provide guidelines, payers, including Medicaid, Medicare, and commercial insurers, often set their own variations. This means practices must be vigilant and payer-specific when coding and billing.
What is OB-GYN Global Package Billing

What Services Are Included in the OB Global Package?

The global maternity package usually covers the routine and expected care provided throughout pregnancy. This includes:
  • Routine prenatal visits:Scheduled check-ups to monitor the mother’s health and the baby’s development.
  • Delivery services: Either vaginal or cesarean delivery, without complications.
  • Immediate postpartum care: Office visits up to 6 weeks after delivery to monitor recovery.
These services are bundled into a few primary CPT codes:
  • 59400 – Routine obstetric care, including vaginal delivery and postpartum care.
  • 59510 – Routine care, including cesarean delivery and postpartum care.
  • 59610 – Routine care including VBAC (Vaginal Birth After Cesarean).
For example, if a patient has 12 prenatal visits, delivers vaginally, and comes back for her postpartum visit, all of those services fall under CPT 59400. No separate claim is needed for each prenatal visit.
This bundling means providers cannot bill separately for every routine exam or delivery-related procedure; they’re already included in the package payment.

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These services are bundled into a few primary CPT codes:

What Services Are Excluded?

While global billing covers routine maternity care, many services do not fall under the package. These must be billed separately to ensure the practice is reimbursed. Common exclusions include:
  • Diagnostic procedures
    such as ultrasounds, fetal non-stress tests, or lab work.
  • High-risk interventions
    like amniocentesis, external cephalic version, or fetal monitoring.
  • Surgical procedures beyond routine delivery
    such as repairing complex lacerations or managing delivery-related complications.
  • Hospital visits unrelated to pregnancy
    such as urinary tract infections, hypertension unrelated to pregnancy, or chronic conditions.
  • Postpartum care beyond the 6-week window
    for instance, a visit for postpartum depression at 3 months is billable separately.
For practices, the challenge is ensuring clear documentation. If the provider documents the reason for the visit and justifies why it falls outside the global package, the billing team can submit a separate claim confidently. Without this clarity, payers may bundle the service incorrectly, resulting in lost revenue.

OB/GYN Global Package Billing Examples

Example 1: Normal Vaginal Delivery

A patient attends 10 prenatal visits, undergoes a normal vaginal delivery, and returns for her postpartum checkup.
  • All these services are billed under CPT 59400. The provider receives one bundled payment for the entire episode of care.

Example 2: Cesarean Delivery with Complications

A patient delivers via cesarean section. A week later, she develops an infection that requires an additional surgical procedure.

  • Initial care billed under CPT 59510.
  • The follow-up surgery is billed separately because it falls outside the global package.

Example 3: Postpartum Visit Beyond Global Period

A patient visits the practice 10 weeks after delivery for postpartum depression counseling.
  • Since the 6-week global postpartum period has passed, this visit is not bundled.
  • It is billed separately using an appropriate E/M CPT code such as 99214.
These real-world examples highlight why understanding inclusions vs. exclusions is crucial. Failing to separate them correctly leads to denials, compliance risks, and financial loss.

Common Challenges in OB/GYN Global Billing

OB/GYN billing is already complex, and global packages add another layer of difficulty. Some of the most common challenges include:
  • Payer-specific variations: Not all insurers interpret global package rules the same way, leading to confusion.
  • Documentation gaps: If a provider doesn’t clearly document why a service is unrelated to pregnancy, it may be denied as bundled.
  • Overlapping services: When multiple providers are involved in patient care, determining who bills for what becomes tricky.
  • High denial rates: Miscoding or failing to separate excluded services often results in denied claims.
These challenges highlight the need for practices to be proactive and well-organized in their billing workflows.
Common Challenges in OB-GYN Global Billing

How to Avoid Revenue Loss in OB/GYN Global Billing

To successfully navigate global billing and protect revenue, practices should implement these best practices:
  1. Stay updated on payer rules: Regularly review payer guidelines, as Medicaid, Medicare, and commercial insurers can all differ in their interpretations of inclusions and exclusions.
  2. Document with precision: Providers must record the reason for every service and ensure it’s tied to the correct diagnosis.
  3. Use specialized billing software: Technology can reduce errors by flagging coding mismatches, automating claim submissions, and tracking bundled vs. non-bundled services.
  4. Conduct routine audits: Regular internal reviews help catch errors before claims are submitted and reduce revenue leakage.
  5. Consider outsourcing: Partnering with a billing expert ensures accuracy, faster reimbursements, and fewer administrative burdens for providers.

READ HERE: 7 Revenue Cycle Management Mistakes

How to Avoid Revenue Loss in OB-GYN Global Billing

MaxRemind’s Expertise in OB/GYN Billing

At MaxRemind, we recognize that OB/GYN global package billing requires more than just general medical billing knowledge; it requires specialized expertise. Our billing team is trained to handle the nuances of maternity care, ensuring every inclusion and exclusion is billed correctly.

Here’s how we help OB/GYN practices succeed:
  • Accurate coding for both routine and complex OB/GYN services.
  • End-to-end revenue cycle management, from charge entry to denial resolution.
  • AI-driven tools to track global package rules and ensure compliance.
  • Tailored solutions that adapt to payer-specific variations.
  • Faster reimbursements so providers can focus on patient care instead of paperwork.
MaxRemind’s Expertise in OB-GYN Billing

By partnering with MaxRemind, OB/GYN practices can significantly reduce denials, improve cash flow, and maintain compliance with payer rules.

Conclusion

Global package billing in OB/GYN is a double-edged sword. On one hand, it simplifies reimbursement for insurers; on the other, it complicates billing for providers. Knowing what services fall inside the package and which ones need to be billed separately can mean the difference between steady cash flow and financial strain.
From routine prenatal visits to complex cesarean cases, the details matter. Practices must stay updated, document meticulously, and bill strategically.
At MaxRemind, we take the stress out of OB/GYN billing. With specialty-specific expertise, AI-powered accuracy, and compliance-driven workflows, we help practices maximize revenue while ensuring patients receive seamless care.

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Contact MaxRemind today and discover how we can transform your OB/GYN billing. Our services are future-ready, efficient, and designed for maximum reimbursement.
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FAQs
What does the OB/GYN global package usually include?

The global maternity package typically includes routine prenatal visits, delivery (vaginal or cesarean without complications), and immediate postpartum care up to six weeks after delivery. All of these services are billed under a single CPT code, such as 59400 for routine vaginal delivery with postpartum care.

What services are excluded from the global maternity package?

Services like ultrasounds, lab tests, high-risk interventions (e.g., amniocentesis), postpartum care beyond six weeks, and visits unrelated to pregnancy are excluded. These need to be billed separately with proper documentation to ensure reimbursement.

Why do different payers have different rules for global OB billing?

While CPT codes provide standardized guidelines, insurance payers such as Medicaid, Medicare, and commercial insurers often apply their own interpretations. This variation requires practices to be payer-specific in their billing to avoid denials.

How can providers avoid claim denials in OB/GYN global billing?

Providers can reduce denials by documenting every service accurately, staying updated on payer-specific rules, separating bundled and non-bundled services correctly, and conducting regular billing audits. Using specialized billing software or outsourcing to experts like MaxRemind also helps ensure compliance.

How does MaxRemind help with OB/GYN global package billing?

MaxRemind offers specialty-focused billing solutions, accurate CPT coding, AI-powered claim tracking, and payer-specific compliance checks. By partnering with MaxRemind, practices can minimize errors, reduce denials, and secure faster reimbursements while focusing more on patient care.