Birth Center and Midwife Billing Services
Birth center and midwife billing services are specialty billing and revenue cycle work built for maternity care where a routine pregnancy billed as separate visits instead of one global package, a birth center facility fee dropped off the claim, or a newborn's care combined onto the mother's claim is the difference between a paid claim and a denial.
EverCure Billing handles the complete revenue cycle for birth centers, certified nurse midwives, and midwifery practices across the United States: eligibility and maternity benefit checks, prior authorizations, maternity coding, claim submission, denial appeals, and aged A/R recovery. Your team delivers the care. We make sure the prenatal, labor, postpartum, and newborn work you already did actually gets paid and holds up if a payer looks.
What Are Birth Center and Midwife Billing Services?
Birth center and midwife billing services cover every financial step between a patient booking prenatal care and that money landing in your practice account.
For a birth center or midwifery practice specifically, that includes verifying maternity benefits and global coverage before care begins, obtaining prior authorization for ultrasounds, labs, and hospital transfers, deciding whether the pregnancy should be billed as one global maternity package or split into components, coding prenatal visits, delivery, postpartum care, and newborn services correctly, separating the facility charge from the professional midwife charge, filing the newborn claim separately from the mother's, posting the payment, appealing the denial when the payer pushes back, and chasing the balance until it clears.
General medical billing stops at "submit the claim." Maternity billing runs on the global package, on split billing when care transfers or insurance changes, on facility-versus-professional charges, and on separate maternal and newborn claims. Those rules make maternity one of the easiest specialties to under-collect on without noticing.
What Problems Do Birth Centers and Midwives Face During Billing?
Because maternity is bundled into a global package, split apart when care changes hands, and spread across facility, professional, and newborn claims detail no generalist biller tracks revenue leaks quietly. These are the specific problems we see when we run audits on birth centers and midwifery practices:
Global maternity package mismanagement
Routine pregnancy care is bundled into one global code covering antepartum, delivery, and postpartum. Bill the visits separately when the global applies and the claim denies as bundled; bill the global when the patient transferred care or changed insurers mid-pregnancy and the practice is underpaid for the work it actually did.
Facility vs. midwife charge confusion
A birth center facility charge and the professional midwife service are two different things. Combine them, or drop the facility component, and the claim underpays and in-house billers miss this constantly.
Newborn and maternal claims combined
The newborn's care and the mother's care are separate claims under separate patient identifiers. Combine them and both deny. Clean, separated billing fixes it.
Antepartum visit-count and split-care errors
When care transfers, antepartum care is billed on its own and the code depends on how many prenatal visits happened (a smaller range versus seven or more). Miscount the visits and the antepartum claim is underpaid.
Out-of-hospital birth coverage and documentation gaps
Home births, water births, and birthing-suite deliveries are covered differently by different payers, with specific place-of-service and documentation requirements. Miss the coverage check or the documentation and a delivered baby becomes a denied claim.
Prior authorization and ultrasound component leaks
Ultrasounds, genetic testing, and hospital transfers need authorization, and ultrasounds have to be split into their professional and technical components when the practice doesn't own the equipment. Skip the auth or mis-split the component and the claim denies or underpays.
We build the workflow around these six failure points, because they are where birth center and midwifery revenue actually disappears.
What Birth Center and Midwife Billing Services Does
EverCure Billing Provide?
Patient access and maternity benefits verification
We verify eligibility, maternity benefits, global maternity coverage, and out-of-hospital birth coverage upfront including deductible and coinsurance status and whether the plan covers birth center facility charges so care isn't delivered on a claim that was never going to pay.
Prior authorization and pre-certification
We prepare and submit authorization requests for ultrasounds, diagnostic labs, genetic testing, and hospital transfers, attach the required clinical documentation, follow up with the payer until a decision is issued, and track expiry dates so approvals don't lapse before the service date.
Charge capture and midwifery coding
Our coders work from your records to assign the correct CPT, ICD-10-CM, and HCPCS codes for prenatal visits, deliveries, postpartum care, and newborn services applying the certified nurse midwife identifier where payers require it, and linking each diagnosis to its service so claims clear medical-necessity edits. Coding and billing are handled together, so coding errors are caught before the claim goes out, not after it's audited.
Global maternity package management
We decide, per patient, whether to bill the bundled global package or split it into antepartum, delivery, and postpartum components so transfers, insurance changes, and mid-pregnancy starts are billed for what actually happened instead of being underpaid.
Facility and professional charge separation
We bill the birth center facility charge and the professional midwife charge correctly and separately, so the facility component isn't lost and the professional service isn't underpaid.
Newborn and maternal claim separation
We file the newborn claim under its own identifier, separate from the mother's, so neither claim denies for being combined.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for global-versus-split logic, facility/professional separation, newborn/maternal separation, payer-specific edits, and diagnosis-to-service linkage before it leaves our office.
Claim submission and denial management
Electronic submission, rejection handling at the clearinghouse level, same-day correction on front-end rejects, and root-cause appeals with the documentation the payer is actually asking for. Denial patterns feed back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar delivery and facility claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations, and a support line so your front desk isn't spending its day explaining maternity coverage and coinsurance.
Provider credentialing and payer enrollment
New midwife and birth center enrollment, re-credentialing, CAQH maintenance, Medicaid enrollment, and Medicare enrollment through PECOS including birth center facility enrollment, which is its own process so a new midwife isn't sitting idle waiting on a payer panel.
AR recovery and real-time reporting
Monthly reconciliations, collections and denial-rate reporting, days in A/R, and payer-specific performance in plain language, not a data dump.
Which Maternity Procedures
Do You Bill?
Prenatal care routine prenatal visits, diagnostic screenings, and maternal health monitoring, coded to payer policy and to the correct global-or-split treatment.
Labor and delivery natural births, water births, home births, and birthing-suite deliveries, with both the facility charge and the professional midwife charge billed correctly.
Postpartum care postpartum check-ups, breastfeeding support, and follow-up maternal care, so every eligible service is captured.
Newborn care newborn assessments, screenings, and wellness visits billed on a separate newborn claim.
Lab and ultrasound obstetric ultrasounds, prenatal lab work, genetic testing, and maternal-fetal monitoring, with medical-necessity documentation and the correct component split.
Cesarean and transfer scenarios accurate coding and modifier use when a birth center or home delivery transfers to a hospital, so the work done at each stage is billed correctly.
Non-covered services clear self-pay and patient-responsibility handling for services a plan was never going to cover, so your practice isn't absorbing the cost.
Which Maternity CPT and ICD-10 Codes
Do You Work With?
| Code / Range | What It Covers |
|---|---|
| 59400 | Global routine obstetric care vaginal delivery (antepartum + delivery + postpartum) |
| 59409 | Vaginal delivery only |
| 59410 | Vaginal delivery, including postpartum care |
| 59425 | Antepartum care only 4 to 6 visits |
| 59426 | Antepartum care only 7 or more visits |
| 59430 | Postpartum care only |
| 59510 | Global routine obstetric care cesarean delivery |
| 59514 | Cesarean delivery only |
| 59610 | Global routine obstetric care vaginal delivery after cesarean (VBAC) |
| 99460–99463 | Newborn care initial, subsequent, and normal newborn services |
| 76801–76817 | Obstetric ultrasound |
| 59025 | Fetal non-stress test |
| Z34.- | Supervision of normal pregnancy |
| Z3A.- | Weeks of gestation (e.g. Z3A.39 = 39 weeks) |
| O80 | Encounter for full-term uncomplicated delivery |
| Z37.- | Outcome of delivery |
| Z39.- | Encounter for postpartum care and examination |
| O09.- | Supervision of high-risk pregnancy |
Code sets update annually, and payer rules including global maternity policy and out-of-hospital birth coverage update more often than that. Keeping current on both is part of the service, not an extra.
Which Codes and Modifiers Actually Decide
Whether a Maternity Claim Gets Paid?
More than any modifier, the decision to bill the global package (59400 / 59510 / 59610) versus antepartum-only, delivery-only, and postpartum-only components decides whether a maternity claim is paid correctly. We make that call per patient based on who provided the care and whether coverage changed.
Certified nurse midwife. Identifies services delivered by a CNM, which many payers require to reimburse the midwife correctly. Missing it can misroute or reduce the payment.
Professional and technical component. Splits ultrasounds into their reading (professional) and equipment (technical) components so each is billed correctly when the practice doesn't own the equipment.
Distinct procedural service. Used to correctly separate legitimately distinct services under bundling edits.
Increased procedural services. Applied for a significantly complicated or prolonged delivery, with the documentation to support the added work.
Birth center, home, and hospital are distinct places of service, and using the wrong one on an out-of-hospital birth is a common denial. We set POS to where care was actually delivered.
The theme in maternity is that correct global-or-split code selection, clean facility/professional/newborn separation, and accurate place of service decide payment far more than any single procedure modifier. That's exactly what we scrub before submission.
How Does Compliance Work in Maternity Billing?
Global package integrity
The global maternity package can be neither unbundled when it applies nor billed whole when care was split. We apply the correct treatment per patient so claims are accurate and defensible.
Facility and professional separation
Birth center facility charges and professional midwife services are billed as the distinct services they are, so the practice bills compliantly and collects fully.
Newborn and maternal separation
Newborn and maternal care are billed as separate claims under separate identifiers, meeting payer rules and avoiding combined-claim denials.
Medical necessity and documentation
Ultrasounds, labs, and higher-level services carry medical-necessity requirements. We tie each to the documentation so claims aren't submitted unsupported.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much of it is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your care model, delivery settings, top payers and Medicaid rules, current denial patterns, and internal handoffs, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R old money is usually the fastest win.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager who understands maternity workflows, and a scheduled review call to go through what's working and what needs to change.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, Practice Fusion, CareCloud, Epic, and Cerner, along with birth-center and midwifery-specific platforms.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide, with a growing footprint in Indiana and New Jersey.
What Does Birth Center and Midwife Billing Cost?
Our birth center and midwife billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on care model, monthly claim volume, payer and Medicaid mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the Business Assessment is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Midwife Billing?
We code and bill together.
In maternity, most lost revenue is a coding decision a global package billed the wrong way, a dropped facility fee, a combined newborn claim. Handling coding and billing in one workflow means those errors are caught before the claim drops, not surfaced later in an audit.
We work the complex claims, not just the easy ones.
Global-versus-split decisions, facility and professional separation, transfers to hospital, and out-of-hospital coverage take documentation review and payer-policy reading. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, your Medicaid rules, and your care model, reachable directly.
Direct access to leadership.
We're built to stay close to our clients. When something goes wrong, you're not escalating through four layers to get an answer.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating. Most billing companies just resubmit.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month, explained clearly.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Birth Center Leaving Money on the Table?
Most birth centers and midwifery practices don't know their real denial rate, how much of their aged A/R is still collectible, or how much they're underpaid on global packages and dropped facility fees until someone actually looks.
That's what the Business Assessment is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Midwife Billing
Yes. We decide, per patient, whether to bill the bundled global package or split it into antepartum, delivery, and postpartum components so transfers and insurance changes are billed correctly instead of underpaid.
Yes. We bill the birth center facility charge and the professional midwife charge as the distinct services they are, so neither is lost.
Yes. We verify out-of-hospital birth coverage per payer, apply the correct place of service, and bill the facility and professional components for each delivery setting.
Yes. We handle both together, which is how coding errors get caught before submission rather than in an audit the single biggest source of lost maternity revenue.
We file the newborn's care on a separate claim under its own identifier, so it isn't denied for being combined with the mother's claim.
Both. Aged A/R is usually where the fastest recovery is available, so we start working it in parallel with new claim submission.
Yes. We prepare and submit the request, attach the clinical documentation, follow up until a decision is issued, and track approval expiry dates.
Yes. Medicaid covers a large share of births and its rules vary by state, so we work to each state's maternity and birth-center requirements.
Yes. Midwife and birth center enrollment, re-credentialing, CAQH maintenance, and Medicaid and Medicare enrollment are all available, either bundled with billing or as a standalone service.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.