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Maternity- Global vs Non-global billing

Date: 01/11/19

Heritage Health (Medicaid):

Global OB care

The total obstetric care package includes the provision of antepartum care, delivery services and postpartum care.

When the same physician group and/or other health care professional provides all components of the OB package, report the Global OB package code.  It is not appropriate to report the antepartum, delivery, and postpartum care separately, when a single physician or the physicians of the same group practice provide the total obstetrical care.

The CPT for Global OB codes are:

59400 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

59510 – Routine obstetric care including antepartum care, cesarean delivery, and postpartum care

59610 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

59618 – Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Billing guidelines

The global maternity allowance is a complete, one-time billing which includes all professional services for routine antepartum care, delivery services, and postpartum care.

The fee is reimbursed for all of the member’s obstetric care to one provider.

If the member is seen four or more times prior to delivery for prenatal care and the provider performs the delivery, and performs the postpartum care then the provider must bill the Global OB code.

Global OB care should be billed on or after the delivery date.

Non-global OB care

Non-global OB care, or partial services, refers to maternity care not managed by a single provider or group practice.

Billing for non-global re may occur if:

  • A patient transfers into or out of a physician or group practice
  • A patient is referred to another physician during her pregnancy
  • A patient has the delivery performed by another physician or other health care professional not associated with her physician or group practice
  • A patient terminates or miscarries her pregnancy
  • A patient changes insurers during her pregnancy 

Billing guidelines

Antepartum care only reporting:

  • If only one to three antepartum visits were provided, report the appropriate E/M codes, according to CPT® guidelines.
  • If four to six visits are provided, report 59425 antepartum care only.
  • If seven or more visits are provided, report 59426 antepartum care only.
  •  Bill date of service span with the total number of visits within the time span. 
  • The dates reported should be the range of time covered. Example: If the patient had a total of 4-6 antepartum visits, then the physician should report CPT code 59425 with from and to dates for which the services occurred.
  • CPT 59425 and 59426 – These codes must not be billed together by the same provider for the same beneficiary, during the same pregnancy.
  • Pregnancy related E/M office visits must not be billed in conjunction with code 59425 or 59426 by the same provider for the same beneficiary, during the same pregnancy. 

Please reference payment policy on Global Maternity (PDF) for additional information.