OB Gyn Medical Billing & Credentialing Services

OB GYN billing requires specialized expertise in complex global maternity packages, distinguishing obstetric from gynecological services, and navigating strict documentation standards that general medical billing services cannot adequately address. Women’s health practices including obstetricians, gynecologists, maternal-fetal medicine specialists, and reproductive endocrinology clinics face unique revenue cycle challenges such as frequent claim denials, global package billing complexities, varying payer policies regarding bundled versus unbundled services, and intricate modifier requirements affecting reimbursement sustainability.

Pro Health Care Advisors delivers comprehensive OB GYN billing solutions designed for small to mid-sized women’s health practices seeking accurate claims processing, reduced denial rates, improved cash flow, and expert guidance navigating the evolving regulatory landscape governing obstetric and gynecological services reimbursement.

Understanding OB GYN Billing Complexities

OB GYN billing differs substantially from other medical specialties due to global maternity care packages bundling prenatal visits, delivery services, and postpartum care into single comprehensive codes that directly determine reimbursement approval or denial. Global obstetric billing using codes 59400 for vaginal deliveries and 59510 for cesarean deliveries includes all routine prenatal visits, delivery procedures, and six weeks postpartum care, requiring precise documentation distinguishing routine bundled services from separately billable complications.

Studies reveal nearly 40% of OB GYN claims face denials or rejections due to coding errors, incorrect modifier usage, or documentation insufficient for medical necessity justification. Pro Health Care Advisors implements systematic quality assurance protocols identifying global package documentation gaps, coding mismatches between diagnosis and procedure codes, missing modifier applications for co-surgeons or antepartum-only services, and incomplete operative reports before claim submission, preventing costly denials and audit vulnerabilities.

Comprehensive Billing Services for Women’s Health Providers

Global Maternity Package Coding and Documentation Management

Our specialists ensure accurate code selection distinguishing complete global packages using 59400 for routine vaginal delivery care and 59510 for cesarean delivery care versus component codes 59425-59426 for antepartum-only services, 59409 for postpartum-only care, and 59612-59614 for delivery-only services when care transfers between providers.

Gynecological Surgery and Procedure Billing Optimization

Gynecological surgery billing demands precise documentation for hysterectomies using 58150 for abdominal approach, 58260-58294 for vaginal approach with various complexity levels, laparoscopic procedures coded 58541-58573, and proper modifier application distinguishing staged procedures from bilateral operations.​

Ultrasound and Diagnostic Imaging Claims Processing

Pro Health Care Advisors manages obstetrical ultrasound billing distinguishing 76801-76802 for complete ultrasounds, 76805-76817 for obstetric ultrasounds with detailed fetal anatomic examination, and limited ultrasounds using 76815, ensuring proper documentation supporting medical necessity and gestational age requirements.​

Office Visit and Consultation Coding for Pregnancy Complications

Office visits addressing pregnancy complications outside routine prenatal care require separate evaluation and management coding using 99202-99215, proper diagnosis linkage supporting medical necessity, and modifier application when services occur during global maternity periods requiring documentation distinguishing complication management from routine care.

Strategic Denial Management Reducing Revenue Loss

OB GYN practices experience substantially higher denial rates than many specialties due to global package billing confusion, insufficient documentation separating routine from complicated care, incorrect diagnosis code linkage, and coverage disputes regarding elective versus medically necessary procedures. Common denial triggers include services exceeding global package scope without proper modifier application, missing prior authorizations for high-risk obstetric management, claims submitted with incomplete operative reports lacking required procedural details, and diagnosis codes inadequately supporting medical necessity for diagnostic procedures like transvaginal ultrasounds.

Our denial management system tracks patterns specific to OB GYN billing including global package component coding errors when patients transfer between providers, documentation insufficient for complications justifying separate billing during global periods, and claims rejected due to bundling edits affecting same-day procedures. We implement corrective action plans addressing root causes, pursue appeals with payer-specific clinical documentation supporting medical necessity and proper global package application, and monitor first-pass resolution rates measuring revenue cycle efficiency.

Revenue Cycle Solutions Beyond Claims Submission

Prior Authorization Management for High-Risk Pregnancy Services

Maternal-fetal medicine consultations, genetic testing, amniocentesis procedures, and high-risk obstetric monitoring often require prior authorization demonstrating medical necessity before payers approve reimbursement. Delays obtaining authorizations postpone essential diagnostic procedures while creating administrative burden requiring systematic tracking systems monitoring authorization status and appeal deadlines.​

Telehealth Billing for Prenatal and Gynecological Consultations

Telehealth services integrated into routine prenatal care remain bundled within global maternity packages and cannot be billed separately despite virtual delivery format. However, telehealth visits addressing complications outside routine care can be billed separately using appropriate evaluation and management codes or CPT 98016 when applicable, requiring documentation distinguishing complication management from routine prenatal monitoring.​

Multiple Insurance Plan Coordination and Verification

Patients frequently change insurance coverage during pregnancy, transitioning between commercial plans, Medicaid enrollment, or Medicare coverage for high-risk conditions requiring systematic eligibility verification before services and proper component coding when global packages cannot apply.

2025 Coding Updates and Payer Policy Compliance

Centers for Medicare and Medicaid Services and commercial insurers continuously update billing guidelines throughout 2025 including new telehealth-specific CPT codes, revised diagnosis code requirements linking procedures to medical necessity, and payer-specific restrictions on diagnostic procedure billing.

Partner with Specialized OB GYN Billing Experts

OB GYN billing complexity demands dedicated expertise understanding global maternity package nuances, gynecological surgery coding requirements, and evolving payer policies affecting women’s health services reimbursement.

Our specialized OB GYN billing services deliver:

• Expert global maternity package coding distinguishing bundled versus component services
• Gynecological surgery billing accuracy with proper modifier application
• Obstetrical ultrasound documentation meeting payer medical necessity standards
• Prior authorization tracking for high-risk pregnancy services and diagnostic testing
• Telehealth billing optimization following 2025 regulatory updates
• HIPAA-compliant systems protecting sensitive reproductive health information
• Denial management addressing OB GYN-specific rejection patterns
• Monthly financial reporting with actionable revenue cycle insights

Pro Health Care Advisors brings boutique service quality ensuring your billing team understands women’s health practice workflows, knows your payer mix challenges intimately, and advocates persistently for maximum reimbursement on every obstetric and gynecological service.