OB-GYN practices provide specialized and essential care, from routine gynecological exams to prenatal care, labor and delivery, surgical interventions, and postpartum services. This unique blend of primary, preventive, and surgical care makes OB-GYN billing particularly complex.

With challenges like global obstetric billing, multiple procedures in a single visit, in-office procedures, diagnostic imaging, and varied payer requirements, OB-GYN billing demands detailed attention to CPT codes, modifiers, timing, and payer rules.

At Progressive RCM, we offer expert OB-GYN medical billing services that help you get paid accurately and quickly — while ensuring compliance with CMS and commercial payer policies. We work as your billing partner, helping your practice grow while you focus on women’s health.

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Why OB-GYN Billing Is So Complex

1. Global Obstetric Billing

OB care is typically billed as a global package, which includes:

• Initial and follow-up prenatal visits

• Delivery (vaginal or C-section)

• Postpartum care (up to 6 weeks)

Billing outside of the global package (e.g., high-risk visits, ultrasounds, complications) requires appropriate modifiers (e.g., 25, 59, 24) to avoid rejections.

2. Multiple Services in One Visit

A patient may receive a Pap smear, ultrasound, family planning, and infection screening during a single encounter. Billing all services without bundling errors or coding conflicts is essential.

3. Surgical and In-Office Procedures

Common OB-GYN procedures include:

• Colposcopy

• LEEP

• Endometrial biopsy

• IUD insertion/removal

• Hysteroscopy
  Each requires correct coding, modifier use, and payer authorization when necessary.

4. Diagnostic Ultrasound and Imaging

OB-GYN practices often own and operate ultrasound machines. Proper documentation, ICD-10 justification, and compliance with technical and professional components are required for reimbursement.

5. Varied Payer Rules

Different payers handle global obstetric billing, family planning services, and preventive screenings in different ways. Tracking authorization, frequency limits, and payer bundling rules is crucial.

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Common CPT, HCPCS, and ICD-10 Codes in OB-GYN Billing

✅ CPT Codes:

• 59400 – Routine obstetric care (vaginal delivery, global)

• 59510 – Routine OB care (C-section, global)

• 76801 – OB ultrasound, first trimester

• 58300 – IUD insertion

• 58100 – Endometrial biopsy

• 57522 – LEEP procedure

• 57454 – Colposcopy with biopsy

• 58661 – Laparoscopy, ovarian cyst removal

• 99213–99215 – Established patient E/M visits

✅ HCPCS Codes:

• J1050 – Medroxyprogesterone acetate (Depo-Provera)

• J7300–J7307 – IUD devices and implants

• Q0091 – Screening Pap smear collection

• G0101 – Cervical or vaginal cancer screening; pelvic exam

✅ ICD-10 Codes:

• Z34.01–Z34.93 – Normal pregnancy by trimester

• O80 – Full-term uncomplicated delivery

• O82 – C-section delivery

• Z30.09 – Family planning and contraception

• N80.0 – Endometriosis

• N92.6 – Irregular menstruation

• N89.8 – Cervical abnormalities

• Z01.411 – GYN exam with abnormal findings

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Our OB-GYN Medical Billing Services

At Progressive RCM, we offer comprehensive billing services designed to support solo OB-GYNs, multi-provider women’s health clinics, and hospital-affiliated practices.

✅ Patient Eligibility & Pre-Authorization

• Verify insurance coverage for OB packages, ultrasounds, and procedures

• Track and obtain prior authorizations for surgeries and imaging

• Ensure documentation supports medical necessity

✅ Global OB Package Management

• Accurately bill 59400, 59510, 59610, etc.

• Track inclusive vs. separately billable services

• Submit claims after delivery and postpartum completion

✅ In-Office Procedure Billing

• Bill IUDs, biopsies, colposcopies, and other minor procedures correctly

• Use modifiers (25, 59, 51) to separate bundled services

• Code supplies, injectables, and device insertions accurately

✅ Ultrasound and Imaging Billing

• Separate technical and professional components

• Track frequency limits and documentation requirements

• Bill first, second, and third trimester scans properly

✅ Claims Management & Payment Posting

• Clean claim submission within 24–48 hours

• Track payer trends and follow up on slow-paying claims

• Post EOBs/ERAs and flag underpayments or denials

✅ Denial Prevention and Appeals

• Identify common OB-GYN denial trends (e.g., bundled services, modifier issues)

• File timely appeals with medical notes and OB records

• Educate providers on coding and documentation improvements

✅ Custom Financial Reporting

• Revenue per provider, visit type, and procedure

• Tracking of global OB package lifecycle

• Denial rate by payer

• Monthly AR summary

• Top revenue-generating codes

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Why Choose Progressive RCM for OB-GYN Billing?

✅ Women’s Health Coding Experts
Our certified coders are trained in ACOG guidelines, global OB rules, and gynecological surgery billing, ensuring every claim is clean and compliant.

✅ Full-Service Revenue Cycle Support
We manage everything from eligibility checks to denials, payment posting, and compliance reporting — so your front desk and clinical staff aren’t burdened.

✅ HIPAA-Compliant and Audit-Ready
We keep your OB-GYN practice aligned with CMS, HIPAA, and private payer rules — minimizing risk and maximizing peace of mind.

✅ Personalized Service for All Practice Sizes
Whether you’re a solo provider or part of a large women’s health network, we offer custom workflows, EHR integration, and dedicated account managers.

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KPIs We Track for OB-GYN Practices

• OB package collection rate

• Claims paid within 30 days

• Modifier-related denial rate

• CPT code-specific reimbursement trends

• Revenue per ultrasound

• E/M vs. procedural visit ratio

• Patient responsibility collection rate

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Final Thoughts

Billing for OB-GYN services is far more than submitting claims — it requires accurate coding, timely tracking of global packages, and in-depth knowledge of women’s health procedures. With so many bundled services, high-risk pregnancies, and surgical interventions, having a reliable billing partner is essential.

At Progressive RCM, we empower OB-GYN practices with specialty billing expertise, allowing you to focus on delivering compassionate and high-quality care — while we handle your revenue cycle with precision and transparency.