Global maternity billing is one of the most misunderstood areas in obstetrics revenue cycle management. Practices routinely leave money on the table, confuse patients, and trigger preventable denials simply because their teams do not fully understand when to bill globally, when to unbundle, and how payer rules differ.
For independent OB/GYN groups, hospital-owned practices, and billing companies, this is not a minor issue. Maternity services often represent a large share of total encounters, and even a 5–10 percent error rate in global maternity billing can translate into hundreds of thousands of dollars in lost or delayed revenue each year.
This playbook is written for decision-makers. It focuses on how to design a clear, enforceable global maternity billing model that your front office, clinicians, coders, and billers can all follow. The goal is simple: fewer surprises, cleaner claims, and a more predictable maternity revenue stream.
1. Clarify What “Global Maternity” Really Means In Your Contracted Payer Mix
Many organizations treat “global maternity” as if it were a single national standard. It is not. CPT and CMS provide a conceptual framework for global packages, but commercial payers vary significantly in how they define included services, global periods, and minimum visit thresholds.
At its core, a global maternity package usually represents one fee that covers three phases of care provided by the same group:
- Antepartum care, a defined number of routine prenatal visits
- Intrapartum care, management of labor and delivery
- Postpartum care, follow-up within a defined postpartum period
However, the operational risk lies in the details. Examples of variation you will encounter across payers include:
- Different expectations for how many prenatal visits must be documented before a global code is allowed
- Different definitions of what counts as routine versus high risk antepartum care
- Different postpartum global periods (for example 6 weeks versus 12 weeks) and how they interact with extended Medicaid coverage
- Different treatment of ultrasounds, fetal surveillance, and procedures such as cerclage or external cephalic version
What to do:
- Identify your top 5–10 maternity payers by volume and revenue.
- Create a one-page “global maternity specification” for each payer: included services, excluded services, global time frames, and coding notes.
- Store these summaries inside your billing playbook or knowledge base, not just in one biller’s head.
Revenue impact: When payer rules are explicit and written down, you avoid a common pattern where the same maternity scenario is billed three different ways by three different staff members. Consistency improves first-pass payment rates and reduces back-and-forth with payers.
2. Decide When You Will Bill Globally Versus Itemized, Then Enforce It
Most OB/GYN groups have at least three different maternity billing patterns in play without realizing it: fully global, partially global, and pure itemized billing. If those patterns are not deliberately defined, your revenue cycle will depend on the subjective judgment of individual coders or physicians.
A sustainable model starts with simple decision logic that anyone can follow. For example:
- Bill global when your group provides:
- Most or all antepartum visits, and
- The delivery, and
- At least one postpartum visit within the global period
- Bill itemized (unbundled) when:
- The patient transfers into or out of your care midway through pregnancy
- Your provider only manages antepartum care or only manages delivery
- The pregnancy ends early due to miscarriage, termination, or fetal demise
- Another practice or hospitalist service provides the delivery
This logic should be tied to specific code families, for example:
- Use global packages such as 59400, 59510, or 59610 when your criteria are met.
- Use antepartum-only and postpartum-only codes when your criteria are not met.
Operational framework:
- Map the decision logic into a short “Maternity Billing Flowchart” that sits in your EHR / billing workflow.
- Require coders to select one of three encounter types at delivery: “Global,” “Antepartum-only,” or “Delivery-only.”
- Run a weekly audit on new deliveries to confirm that coding selection aligns with documentation and payer specifications.
Common mistake: Many practices attempt to force a global package even if the group did not truly provide global care. Payers can and do recoup these overpayments during audits, especially if the number of antepartum visits appears low for a full-term pregnancy. You trade short-term cash for long-term risk.
3. Build A Prenatal Visit Tracking System That RCM Actually Uses
From a revenue cycle perspective, global maternity billing is only as accurate as your prenatal tracking. If you cannot answer “how many prenatal visits did we provide under this pregnancy episode and on what dates,” your global billing decisions will always be approximate.
Many EHRs support pregnancies as episodes of care, but practices often underuse those capabilities. Instead, staff rely on loose chart review at the time of delivery. That is slow, expensive, and prone to error.
Design a tracking approach with these components:
- Episode identifier. Every pregnant patient should have a unique pregnancy episode ID or label tied to the estimated due date and payer. If a patient becomes pregnant again, a new episode is created rather than reusing the prior one.
- Visit classification. Each encounter should be classified as routine prenatal, high risk prenatal, non-obstetric, or unrelated. This can be driven by templates or visit types in the scheduling system.
- Minimum-visit logic. Your billing rules should know when you have met a payer’s minimum number of antepartum visits to qualify for the global package. When that threshold is reached, a flag can appear in the work queue for your coding team.
Example KPI set for prenatal tracking:
- Percentage of maternity episodes with correct payer and due date assigned before 20 weeks
- Percentage of global maternity claims where the documented prenatal visit count meets or exceeds payer minimum
- Number of post-payment recoupments triggered by “insufficient antepartum care for global billing”
Even a simple spreadsheet or dashboard that summarizes antepartum visits by patient and payer can dramatically improve your decisions at the time of delivery coding.
4. Separate “Included” Versus “Excluded” Services Before Claims Go Out
One of the most profitable improvements you can make is to get very clear about which services are normally included in the global maternity fee versus which services are billable on top of the package. Practices often lose revenue because everything is treated as “part of prenatal care,” even when payers allow or expect separate billing.
Typical categories that are often billable separately, subject to payer policy, include:
- Diagnostic ultrasounds and detailed sonography
- Fetal non-stress tests, biophysical profiles, or Doppler studies
- Genetic counseling and certain maternal-fetal medicine consultations
- Procedures such as amniocentesis or external cephalic version
- Management of unrelated conditions, for example urinary tract infection or asthma exacerbation
An operational checklist before final maternity claim submission:
- Confirm that all billable diagnostic tests during the pregnancy are on separate encounters and that technical/professional splits are handled correctly if applicable.
- Ensure high risk or complication-related visits have appropriate E/M or procedure codes and are not masked by the global package alone.
- For postpartum care, confirm which visits are truly routine and which are for complications such as wound infections, hypertension, or mood disorders.
Revenue impact: A structured review can add significant incremental revenue per pregnancy, especially in high-risk populations. More importantly, it reduces the chance of miscoding that leads to payer accusations of “double billing” when a service is not properly distinguished from the global package.
5. Hard-wire Documentation Requirements For Antepartum, Delivery, And Postpartum Phases
Global maternity billing is only defendable during audits if your documentation supports each phase of care. Revenue leaders should treat documentation standards as part of the revenue strategy, not just a compliance checkbox.
Antepartum documentation should consistently capture:
- Gestational age and estimated due date
- Risk status: routine versus high risk, with supporting diagnoses
- Key vitals and fetal assessment findings
- Patient counseling and decisions made (for example VBAC vs repeat cesarean)
Delivery documentation should include:
- Exact date and time of delivery
- Type of delivery (spontaneous vaginal, assisted vaginal, primary or repeat cesarean, VBAC)
- Whether multiple gestation was delivered and how many infants
- Any complications that justify additional coding or separate claims (for example shoulder dystocia, postpartum hemorrhage)
- Which provider actually performed the delivery if call coverage is shared
Postpartum documentation should distinguish between:
- Routine postpartum wellness visits within the global period
- Visits for complications or unrelated conditions that require separate E/M coding
- Visits after the end of the payer’s postpartum global period, which should not be written off as included
Practical step: Create structured templates or smart phrases for each phase of care so that critical elements are easy to capture. Then partner with your coding team to build quick feedback loops when providers omit information that affects code selection.
Good documentation protects you in audits, supports proper coding of complications, and gives denials specialists the narrative they need to overturn payer rejections.
6. Use Preemptive Edits And Analytics To Control Denials Instead Of Reacting To Them
Global maternity claims are rich with denial risk. Common denial rationales include “global package not appropriate,” “antepartum care billed twice,” “delivery already paid to another provider,” or “service included in global obstetric package.” Waiting until those denials hit is an expensive way to manage your revenue cycle.
A more mature approach uses front-end edits and analytics.
Examples of useful pre-submission edits:
- Flag global maternity codes submitted when no prior prenatal encounters exist in your system.
- Flag claims where both a global package and separate antepartum-only codes are being submitted for overlapping dates of service for the same pregnancy episode.
- Flag deliveries where payer eligibility shows the patient moved into a Medicaid plan mid-pregnancy, requiring special handling or split billing.
Denial analytics that every OB/GYN revenue leader should see monthly:
- Top 10 denial reasons for maternity claims by payer
- First-pass acceptance rate for global maternity codes versus itemized maternity codes
- Average days to payment for global versus non-global maternity claims
- Dollar value of recoupments specifically tied to maternity audits
These metrics help you prioritize fixes. For example, if one commercial payer frequently denies global claims because the patient changed groups during pregnancy, you may choose to default to itemized billing for that payer when there is any hint of transfer of care.
If your internal analytics capacity is limited, consider partnering with an experienced RCM vendor or leveraging platforms that specialize in claim auditing. One of our trusted partners, Quest National Services medical billing, focuses on full-service billing and denial prevention for practices that need deeper support with payer-specific maternity rules.
7. Align Front Office, Clinical, And Billing Teams Around One Maternity RCM Playbook
The final ingredient is alignment. Even the best coding rules will fail if scheduling, registration, and clinicians are not working from the same playbook. In maternity care, breakdowns often begin long before a claim is coded.
Key cross-functional touchpoints you should standardize:
- At scheduling and registration: Confirm pregnancy status, expected due date, and insurance coverage type. If the patient is switching into your practice, capture prior OB provider information at the first touch.
- At check-in: Confirm that insurance has not changed since the last visit and that any payer-mandated referrals or authorizations are in place.
- At the first prenatal visit: Assign the pregnancy episode in the EHR and tag the payer’s global maternity rules from your reference guide.
- When transfers occur: Implement a brief, standardized handoff form that captures how many prenatal visits occurred elsewhere and whether the prior provider will bill globally.
Governance and training model:
- Publish a concise “Global Maternity Billing Playbook” that covers payer rules, coding logic, documentation requirements, and escalation paths.
- Review this playbook in onboarding for new providers, coders, and front-desk staff.
- Revisit it at least annually, or sooner when major payers update maternity policies.
When everyone shares the same understanding, you reduce finger pointing between clinical and billing teams and create a stable framework for continuous improvement.
8. Prepare For Policy Shifts: Extended Postpartum Coverage And Virtual Care
The policy landscape around maternity care continues to evolve. Many Medicaid programs and some commercial plans have expanded postpartum coverage well beyond the traditional 6-week period. At the same time, telehealth is now embedded in prenatal and postpartum care for many patients.
Neither of these shifts automatically fits into historical global billing patterns.
Postpartum coverage extensions:
- Some payers still treat only a small slice of the postpartum window as “included” in the global fee and will cover additional postpartum visits separately.
- Others attempt to apply broad bundling logic across the entire extended postpartum period.
It is not safe to assume that every postpartum encounter for 12 months is non-billable. Your payer reference sheets should explicitly address how each plan handles extended postpartum care, particularly for mental health, lactation support, and management of chronic conditions that emerge after delivery.
Virtual prenatal and postpartum visits:
- Some payers treat telehealth visits as equivalents to in-person prenatal checkups for purposes of global maternity thresholds.
- Others allow separate reimbursement for certain types of remote monitoring or virtual counseling.
Revenue leaders should work with compliance and clinical leadership to:
- Map which virtual visit types are included in global bundles versus reimbursed separately.
- Confirm how virtual visit CPT and place-of-service coding interacts with maternity modifiers and global designations.
- Train providers to document modality and duration clearly so coders can apply correct rules.
Practices that keep their maternity billing rules static while payer policies shift around extended care and telehealth will either leave revenue untouched or draw unnecessary audit attention.
Driving Better Maternity Revenue Outcomes: Next Steps For Leaders
Global maternity billing rewards organization and punishes improvisation. When your payer rules are vague, your episode tracking is incomplete, and your documentation is uneven, you will see it in rising denials, recoupments, and unstable maternity revenue.
On the other hand, when you treat global maternity as a defined RCM program, not just a set of codes, you see concrete benefits:
- Higher first-pass payment rates on delivery and package claims
- More consistent capture of billable diagnostics and complication care
- Fewer payer disputes when patients transfer care mid-pregnancy
- Clearer expectations for patients about what services are covered and when additional costs might apply
For many organizations, the practical path forward looks like this:
- Inventory your current maternity billing patterns and denial trends by payer.
- Draft or update a written global maternity playbook that covers rules, codes, and workflows.
- Implement basic episode and prenatal tracking so delivery coding is based on data rather than memory.
- Introduce pre-submission edits and denial analytics focused specifically on maternity scenarios.
- Reinforce training and governance so your model survives staff turnover.
If your internal team is stretched thin, outside expertise can accelerate this process. If your organization is looking to improve billing accuracy, reduce denials, and strengthen overall revenue cycle performance, working with experienced RCM professionals can make a measurable difference. One of our trusted partners, Quest National Services, specializes in full-service medical billing and revenue cycle support for healthcare organizations navigating complex payer environments.
Whether you optimize in-house or with external help, the objective is the same. Treat global maternity billing as a strategic revenue lever, and your OB/GYN service line will reward you with more predictable cash flow and fewer payer headaches.
To discuss how these concepts apply to your own OB/GYN or women’s health program, you can connect with us through our contact page and start building a maternity billing model that your payers, providers, and patients can all understand.
