Obstetrics & Gynecology Billing & Coding Guide
Global OB package, antepartum/postpartum care, LARC insertions, well-woman 99385-99397.
Common Obstetrics & Gynecology CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 59400 | Obstetrical care | 37.00 | 66.30 | MMM |
| 59409 | Obstetrical care | 14.37 | 21.61 | MMM |
| 59410 | Obstetrical care | 18.76 | 29.23 | MMM |
| 59425 | Antepartum care only | 7.80 | 17.21 | MMM |
| 59426 | Antepartum care only | 14.30 | 31.60 | MMM |
| 59430 | Care after delivery | 3.22 | 7.82 | MMM |
| 59510 | Cesarean delivery | 41.05 | 74.05 | MMM |
| 59514 | Cesarean delivery only | 16.13 | 24.66 | MMM |
| 59515 | Cesarean delivery | 22.79 | 36.67 | MMM |
| 59610 | Vbac delivery | 38.71 | 69.78 | MMM |
| 59618 | Attempted vbac delivery | 41.57 | 74.86 | MMM |
| 59620 | Attempted vbac delivery only | 16.66 | 25.52 | MMM |
| 59622 | Attempted vbac after care | 23.32 | 37.82 | MMM |
| 58300 | Insert intrauterine device | 0.98 | 3.16 | XXX |
| 58301 | Remove intrauterine device | 1.24 | 3.34 | 000 |
| 58661 | Laparoscopy remove adnexa | 11.07 | 17.55 | 010 |
| 58662 | Laparoscopy excise lesions | 11.85 | 19.36 | 090 |
| 57454 | Bx/curett of cervix w/scope | 2.27 | 4.97 | 000 |
| 57455 | Biopsy of cervix w/scope | 1.94 | 4.82 | 000 |
| 99381 | Init pm e/m new pat infant | 1.50 | 3.40 | XXX |
What Obstetrics & Gynecology practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
Antepartum-only care (59425 at 7.8 RVU, 59426 at 14.3 RVU) significantly undercoded when obstetric patient referred mid-pregnancy. Average practice loses 3-5 cases/month by incorrectly billing E/M codes instead of global antepartum package. Impact: $2,000-4,000/month per provider. Solution: Protocol requiring intake form confirming antepartum transfer date and explicit coding decision tree in EMR.
Modifier 25 on preventive E/M same-day as gynecologic procedure (57454, 57455, 58661) claimed in <8% of eligible encounters. Medicare allows separate payment when documentation supports distinct E/M (different problem, separate note). Average preventive E/M (99385/99395) at $150-200 each, performed at 40% of same-date procedure visits. Impact: $1,200-2,000/month per provider if captured. Requires provider education on documentation of medical decision-making unrelated to procedure.
Postpartum care code 59430 (3.22 RVU, $120-150 per claim) underbilled. Many practices bundle into global 59400 but miss opportunity to bill separate postpartum-only visits beyond day 1-2. Impact: 2-4 claims/month per OB provider at $300-600 annual revenue. Solution: Chart audit to identify visits after day 3 postpartum that should be coded 59430 vs bundled into global.
Laparoscopic lesion excision (58662, 11.85 RVU) versus routine laparoscopic diagnostic (not in database) often undercoded as diagnostic when pathology report confirms lesion requiring therapeutic intervention. Impact: Loss of $400-600/case. Requires operative note documentation of specific lesion treated (size, location, type) with pathology confirmation. Approximately 30% of coded cases qualify for upgrade on retrospective audit.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Obstetrics & Gynecology. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
Global obstetric package codes are mutually exclusive. Cannot bill 59400 (full OB care vaginal) with 59510 (full OB care cesarean) for same pregnancy. Modifier 59 does not bypass this exclusion, even if patient switches delivery method mid-pregnancy. Use 59425/59426 (antepartum only) + 59514 (cesarean delivery only) to split care between providers or episodes.
Laparoscopic removal of adnexa (58661, global 010) bundles with laparoscopic excision of lesions (58662, global 090) when performed same session on same side. Modifier 59 or XS only applies if distinctly different anatomy or organs treated. Documentation must specify separate anatomic sites (e.g., cyst excision on right ovary AND fibroid excision on left uterine horn).
Cervical biopsy with curettage (57454) includes cervical biopsy (57455). Cannot bill both same session. 57454 has higher RVU (2.27 vs 1.94). Bill only 57454 when curettage performed. Use 57455 alone when biopsy without curettage. Modifier 59 not appropriate here due to inherent bundling.
IUD removal (58301, global 000) and IUD insertion (58300, global XXX) can be billed together same session only if removal of prior device and insertion of new device occur on same date. No modifier required if documented as device exchange. If separate visits, bill only applicable code per date of service.
Modifier Guidance for Obstetrics & Gynecology
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 appended to E/M code (e.g., 99385-25) when significant, separately identifiable evaluation performed same day as OB procedure. Example: Patient presents for annual preventive visit at 18 weeks gestation, documented separately with expanded history/exam, then undergoes cervical biopsy (57455) for abnormal Pap. Bill 99385-25 and 57455 separately only if E/M documentation shows distinct problem-focused elements unrelated to the biopsy procedure itself.
Modifier 59 bypasses NCCI edits for normally bundled services when distinctly separate procedures performed. In OB/GYN context, use sparingly and only when anatomy or procedural intent clearly separate. Example: Laparoscopic left salpingectomy (58661-LT) plus diagnostic laparoscopy for endometriosis on right (58662-RT-59). Requires operative note explicitly describing two separate pathologies and two separate operative sites. Many MACs audit 59 use aggressively in this specialty.
Multiple procedure modifier 51 appended to all but highest-RVU procedure when multiple non-E/M procedures performed same session. Example: Cervical biopsy (57454) and IUD removal (58301-51) same visit. Some payers bundle instead of reducing, so verify payer-specific reimbursement rules before appending. Medicare typically reduces secondary procedures 50% but commercial carriers vary.
Decision for surgery modifier 57 appended to E/M code when evaluation results in decision to perform major surgery (RVU >20). Example: Patient presents with heavy bleeding, undergoes 99285 office visit with counseling, decision made to proceed with laparoscopic myomectomy (58662). Bill 99285-57 only if documented as separate E/M encounter initiating surgical planning, not pre-op work performed day-of-surgery.
Physical therapy modifier GP not typically used in Obstetrics & Gynecology coding unless postpartum rehabilitation services (pelvic floor PT) billed under therapy codes, which are outside core OB/GYN CPT set in this database. If applicable, GP indicates services under outpatient PT plan of care per payer requirements. Rare in this specialty.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Operative note must specify laterality (left/right) and anatomy treated when claiming modifier 50 or LT/RT for bilateral procedures, or when claiming 59 for separate structures. RAC audits laterality discrepancies as denials at 60% rate.
- Global obstetric package (59400, 59410, 59510, 59610) requires antepartum visit dates, delivery date, and postpartum visit dates documented in chart. Missing any element triggers LCD denial under most MACs. Include patient-initiated calls and routine follow-up visits.
- Cervical biopsy specimens must be documented with location (anterior, posterior, lateral), number of samples, and pathology order number. Payers deny duplicate biopsy (57454 vs 57455) claims at 45% rate when specimen log missing.
- IUD removal documentation must include removal date, reason for removal, patient tolerance, type of device removed (if prior device), and confirmation of complete removal. Incomplete removal requiring second procedure coded as 78 (unplanned return), not repeated 58301.
- Laparoscopic adnexa removal (58661) versus lesion excision (58662) requires explicit intra-operative findings noting whether organ removal intended or conservation-focused (e.g., cystectomy vs oophorectomy). Charts stating only 'laparoscopy performed' trigger 25% recoupment by MACs.
- Antepartum-only codes (59425, 59426) require documentation of delivery care transferred to different provider with date of transfer. Without explicit transfer documentation, payers downcode to full package code and demand refund of difference.
OIG and audit triggers in Obstetrics & Gynecology
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
OIG Work Plan 2024-2026 targets obstetric package billing accuracy, specifically improper coding of antepartum-only and delivery-only components when full package should apply. RAC focus: providers splitting 59400 into 59425 + 59514 without documented transfer of care. Defense requires explicit documentation of handoff date and reason (change of provider, referral after certain gestational age, etc.). Expect 15-25% recoupment if handoff not documented.
Cesarean delivery billing (59510 vs 59514 vs 59515) audited for global period compliance and whether antepartum care included. RAC pattern: coding 59514 (delivery only) for patient with 10+ antepartum visits at same practice. Downcode to 59510 and demand refund. Defense: chart must show documented referral or change of provider with effective date before delivery.
Bilateral procedure modifier 50 denials spike when gynecologic surgery claims lacking anatomic specificity. Example: Laparoscopic treatment coded as 58662-50 without operative note documenting distinct pathology on each ovary. Result: 60% denial rate for lack of medical necessity on second side. Require separate findings documentation per side.
IUD removal/insertion bundling (58301 + 58300) triggers 35% denial rate when coded same visit without 'device exchange' documentation. Payers view as single service. Defense requires explicit documentation that prior device was removed in its entirety and new device placed, with part numbers or lot numbers of devices if available. Missing detail results in full denial of secondary code.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Obstetrics & Gynecology.
ME Medicare +
Local Coverage Determination (LCD) for obstetric global package (59400, 59410, 59510, 59610) requires completion of antepartum, delivery, and postpartum components within defined timeframe. CMS allows split billing only when documented provider transfer occurs. No prior authorization required for routine OB care, but elective repeat cesarean (59510) may require medical necessity documentation under some MACs. 2026 policy update: increased scrutiny on telehealth obstetric E/M codes (add modifier 95) for antepartum visits; confirm payer acceptance per MAC.
UN UnitedHealthcare +
Optum delegated plans require prior authorization for laparoscopic procedures (58661, 58662) when coded electively (non-emergency). Standard authorization timeline 3-5 business days. Modifier 59 requires pre-auth notation in claim or automatic denial triggered. Obstetric global package follows same guidelines as Medicare but some Optum plans carve out antepartum visits for separate E/M reimbursement if distinct from OB care (e.g., annual preventive + OB). Verify delegation status per region before claim submission.
AN Anthem +
Anthem Individual Coverage Request (ICR) process applicable to laparoscopic adnexa removal (58661) and excision procedures (58662) when documented as elective or diagnostic. Standard turnaround 5 business days. Prior authorization required for repeat cesarean (59510) in some plans; auto-approved if medical necessity documentation provided (e.g., prior classical incision, suspected placenta previa). Bilateral procedure modifier 50 auto-denied without separate operative note findings per side. Modifier 59 requires manual review; expect 10-15 day processing.
CI Cigna +
Cigna does not typically delegate OB/GYN to eviCore radiology, but surgical pre-authorization required for laparoscopic cases (58661, 58662) under medical surgical policy. Obstetric global package bundled; no separate E/M reimbursement unless coded with modifier 25 with explicit documentation. IUD insertion (58300) often subject to medical policy requiring pre-auth if off-label use (e.g., IUD for contraception in adolescent, requiring documented medical exception). Denial rate for IUD claims 15-20% without prior verification.
Standard Obstetrics & Gynecology coding workflow
Step 1: Identify service date and confirm if obstetric global package (single CPT 59400-59622) or component-based split (59425/59426 + 59514/59515/59620/59622 + 59430). Step 2: Pull operative/visit note and abstract laterality, specimen data, and anatomic locations for all procedures. Step 3: Check NCCI pairs in payer manual for same-date bundles (e.g., 57454 with 57455). Step 4: Apply modifiers (59, 51, LT/RT, 25) only with documented clinical justification matching payer LCD. Step 5: Query clearinghouse NCCI file and run manual rate contract validation before claim submission.
Get the full PayerReady toolkit
Credentialing + billing/coding tools built for Obstetrics & Gynecology, free access with enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Verified against CMS 2026 code set, current NCCI Quarterly Updates, and the X12 Claim Adjustment Reason Code reference. Last updated April 15, 2026. See data sources and methodology.
Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team