OB/GYN Billing Services
OB/GYN billing services are specialty billing and revenue cycle services built specifically for obstetrics and gynecology practices where a delivery billed under the wrong global maternity code, or an antepartum visit count that doesn't match the package rule, is the difference between a fully-paid pregnancy and thousands of dollars quietly lost per patient.
EverCure Billing handles the complete revenue cycle for OB/GYN providers across the United States: eligibility checks, prior authorizations, obstetric and gynecologic coding, claim submission, denial appeals, and aged A/R recovery. Your team cares for the patient through pregnancy and surgery. We make sure the antepartum, delivery, postpartum, and gynecologic work you already did actually gets paid and holds up if a payer looks.
What Are OB/GYN Billing Services?
OB/GYN billing services cover every financial step between a patient booking a visit and that money landing in your practice account.
For an OB/GYN practice specifically, that includes verifying benefits before a procedure, obtaining prior authorization for surgeries and imaging, coding each service with the correct CPT, ICD-10, and modifier combination including the global maternity package that bundles an entire pregnancy into a single code counting antepartum visits correctly, documenting medical necessity for repeat ultrasounds, submitting a clean claim, 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." OB/GYN billing runs on the global maternity package, the antepartum visit thresholds, and the split-care rules that decide whether a pregnancy is billed as one code or itemized and a single wrong call there loses the whole delivery's margin. That combination makes OB/GYN one of the easiest specialties to under-bill without ever seeing an obvious denial.
Why Do OB/GYN Practices Lose More Revenue Than Other Specialties?
Because OB/GYN mixes bundled global packages, visit-count rules, and heavily-audited same-day combinations that no generalist biller tracks and a lot of the loss is silent under-billing, not a flagged denial. These are the specific leaks we see when we run audits on OB/GYN practices:
Global maternity package applied wrong
The global codes (vaginal, cesarean, VBAC) bundle antepartum, delivery, and postpartum into one code. If care was actually shared, transferred, or the patient's coverage changed mid-pregnancy, the practice should itemize and when it doesn't, it either under-bills its own work or double-bills what another provider already claimed.
Antepartum visit count mismatch
When the practice provides only part of the pregnancy, the number of prenatal visits decides which code applies individual E/M, the 4–6 visit code, or the 7-or-more code. Bill the global by habit when the visit count doesn't support it, and the claim is exposed on audit; bill E/M when a package applied, and you leave money on the table.
Repeat ultrasound denials
Obstetric ultrasounds are covered against medical-necessity and frequency expectations, and the professional/technical split matters when equipment ownership varies. Miss the indication in documentation, or bill the wrong component, and repeat scans deny.
Preventive plus problem visit on the same day
A well-woman exam and a separately-identifiable problem visit on the same day is legitimate but only with a properly documented modifier 25. It's one of the most audited combinations in medicine, and OB/GYN sits right in it. Missing or unsupported, the payer pays one and denies the other.
Surgical global periods and multiple procedures
Hysterectomy, myomectomy, and laparoscopic procedures carry global periods, bilateral rules, and multiple-procedure reduction logic. Miss the laterality, bilateral, or distinct-service modifier and the claim underpays.
Medicaid vs. private payer and sterilization consent
A large share of deliveries run through Medicaid, which carries its own rules including the timed sterilization consent form. Miss the consent window or the payer-specific documentation and a completed procedure simply doesn't pay.
We build the workflow around these six failure points, because they are where OB/GYN practice revenue actually disappears.
What OB/GYN Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
We verify active coverage, plan type, deductible status, coinsurance, and maternity benefits before the patient arrives including whether the pregnancy runs through Medicaid or a private payer, so care isn't delivered on a claim that was never going to pay the way the practice assumed.
Prior authorization support
We prepare and submit authorization requests for hysterectomies, LEEP and cervical procedures, sterilizations, advanced imaging, and other surgeries, 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.
OB/GYN medical coding
Our coders work from your chart notes to assign the correct CPT, ICD-10-CM, and HCPCS codes applying global maternity logic, antepartum visit counts, trimester and weeks-of-gestation coding, ultrasound components, laterality and bilateral modifiers, and surgical global periods, and linking each diagnosis to its procedure 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.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for payer-specific edits, NCCI bundling conflicts, global-package logic, modifier accuracy, and diagnosis-to-procedure linkage before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification because payers do pay below contracted rates on deliveries and surgeries, and most practices never catch it.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the supporting documentation the payer is actually asking for. We also feed denial patterns 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 surgical 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 provider enrollment, re-credentialing, CAQH maintenance, and Medicare and Medicaid enrollment so a new OB/GYN in your group isn't sitting idle waiting on a payer panel.
Billing audits and compliance review
Periodic internal review of coding accuracy, global-package application, modifier 25 usage, and ultrasound medical necessity to reduce audit exposure before a payer finds it first with audit-defense documentation prepared for high-scrutiny codes.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which OB/GYN Procedures
Do You Bill?
Obstetric care (maternity) Antepartum, delivery, and postpartum care billed under the correct global maternity package, or itemized when care is shared or transferred, with the antepartum visit count matched to the right code.
Vaginal and cesarean deliveries Global delivery coding with VBAC and attempted-VBAC handling, multiple-gestation logic, and correct assignment when more than one provider in the group participates.
Obstetric and pelvic ultrasound Trimester-appropriate scans coded against medical necessity, with the professional/technical split and repeat-scan indications handled so imaging pays.
Hysterectomy Abdominal, vaginal, and laparoscopic hysterectomy with global-period tracking and multiple-procedure reduction logic so surgical claims pay at the correct rate.
Myomectomy Open and laparoscopic fibroid removal coded to approach and complexity.
LEEP and cervical procedures Conization, LEEP, and colposcopy with biopsy, coded to the covered indication with the abnormal-Pap diagnosis linked.
Hysteroscopy and endometrial procedures Diagnostic and operative hysteroscopy, endometrial biopsy, and D&C including D&C after miscarriage coded to indication.
Contraceptive and sterilization procedures IUD insertion and removal, and tubal ligation/occlusion with the timed sterilization-consent workflow where Medicaid requires it.
Well-woman and problem visits Preventive exams and same-day preventive-plus-problem visits handled through correct, well-documented modifier 25 support.
Non-covered and elective services ABN workflow and patient-responsibility handling so your practice isn't absorbing the cost of services the payer was never going to cover.
Which OB/GYN CPT and ICD-10 Codes
Do You Work With?
| Code Range | What It Covers |
|---|---|
| 99202–99215 | New and established patient E/M visits |
| 99381–99397 | Preventive / well-woman visits |
| 59400 | Global vaginal delivery (antepartum, delivery, postpartum) |
| 59510 | Global cesarean delivery |
| 59610, 59618 | VBAC and attempted VBAC converted to cesarean |
| 59425, 59426 | Antepartum care only (4–6 visits / 7+ visits) |
| 59430 | Postpartum care only |
| 76801–76817 | Obstetric and pelvic ultrasound |
| 57452–57461 | Colposcopy with and without biopsy |
| 57500–57522 | Cervical biopsy, conization, and LEEP |
| 58100, 58120 | Endometrial biopsy and D&C |
| 58150–58294 | Abdominal and vaginal hysterectomy |
| 58541–58573 | Laparoscopic hysterectomy |
| 58558–58565 | Hysteroscopy (diagnostic and operative) |
| 58300, 58301 | IUD insertion and removal |
| 58600–58671 | Tubal ligation and occlusion |
| 58140–58146, 58545–58546 | Open and laparoscopic myomectomy |
| Z34.- | Supervision of normal pregnancy |
| O09.- | Supervision of high-risk pregnancy |
| Z3A.- | Weeks of gestation |
| O24.4- | Gestational diabetes |
| O13.-, O14.- | Gestational hypertension and pre-eclampsia |
| D25.- | Uterine leiomyoma (fibroids) |
| N80.- | Endometriosis |
| N83.- | Ovarian cyst |
| R87.61- | Abnormal cytological findings on cervical Pap |
Code sets update annually and payer rules including global-package and medical-necessity policy update more often than that. Keeping current on both is part of the service, not an extra.
Which Modifiers Actually Decide Whether
an OB/GYN Claim Gets Paid?
Significant, separately identifiable E/M on the same day as a procedure or preventive visit. Heavily audited in OB/GYN, which is exactly why it has to be documented properly.
Distinct procedural service, used to correctly separate legitimately separate procedures under bundling edits.
Bilateral procedures, so bilateral tubal and bilateral ovarian work is reported and paid correctly instead of at a single-side rate.
Laterality, distinguishing left from right for ovarian and adnexal procedures.
Multiple procedures in the same session, so reduction logic is applied correctly rather than the claim being denied or over-reduced.
Increased procedural services for an unusually difficult delivery or surgery, supported by documentation.
Unrelated E/M during a surgical or postpartum global period, so a legitimately separate visit isn't bundled into the global.
Decision for surgery, distinguishing the visit where surgery was decided from a routine pre-op.
Staged, related unplanned return, or unrelated procedures during a surgical global period.
Repeat procedure by the same or a different physician, relevant for repeat ultrasounds.
Professional and technical component split for imaging, based on who owns the equipment.
Advance beneficiary notice and non-coverage indicators for elective and statutorily non-covered services.
How Does Compliance Work in OB/GYN Billing?
Global maternity package rules
A pregnancy is billed as one global code only when the practice provided the full course of care. We apply the antepartum visit thresholds and the split-care rules so shared, transferred, and coverage-change pregnancies are itemized correctly the practice bills all of its own work and none of another provider's.
Modifier 25 discipline
Preventive plus a same-day problem visit is one of the most audited billing patterns in medicine, and OB/GYN is squarely in that spotlight. We hold modifier 25 to the documentation standard so it stands up to review.
Ultrasound medical necessity and frequency
Repeat obstetric ultrasounds need a documented indication, and the professional/technical split has to match equipment ownership. We build that into the claim so imaging clears medical-necessity edits.
Sterilization consent and Medicaid rules
Medicaid sterilization requires a valid, timed consent form, and maternity Medicaid carries payer-specific documentation. We track the consent window and payer requirements so completed procedures actually pay.
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 procedure mix, top payers, 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, 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 OB/GYN-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 OB/GYN Billing Cost?
Our OB/GYN billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on procedure mix, monthly claim volume, payer 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 free audit is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for OB/GYN Billing?
We code and bill together.
In OB/GYN, most lost revenue is a coding decision a mis-applied global package, an antepartum count that doesn't match, a missing bilateral modifier. 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 maternity splits, surgical global periods, and repeat-ultrasound necessity 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, and your procedure mix, 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 OB/GYN Practice Leaving Money on the Table?
Most OB/GYN practices don't know how many of their deliveries were billed under the wrong package, how much of their aged A/R is still collectible, or how much repeat imaging is denying that should have been covered until someone actually looks.
That's what the free audit 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 OB/GYN Billing
Yes. Our team works with the detail OB/GYN billing requires global vaginal, cesarean, and VBAC packages, antepartum visit thresholds, split-care and transfer situations, and postpartum coding. General billing knowledge alone doesn't cover any of that.
Because a lot of the loss is silent under-billing, not a flagged denial a global package applied where care was actually shared, a missing bilateral modifier, an unsupported repeat ultrasound. We code to the correct package and modifiers so the practice captures all of its own work.
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 OB/GYN revenue.
Yes. We log into your current system and work inside it. There is no software to buy and no migration required.
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. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare and Medicaid 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.
Ready to Fix Your OB/GYN Revenue Cycle?
Every mis-packaged delivery and every aged account is money your practice already earned. Let's go get it.
📧 info@evercurebilling.com⚠️ Fill these in before publishing
• Verify the code table have a coder confirm the CPT/ICD-10 ranges against the current year before publishing, especially the delivery and hysterectomy code families. Codes here are accurate at a page level but should be checked, not published blind.
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