For solo gynecology offices, multi-provider OB/GYN groups, midwifery and birth center practices, maternal-fetal medicine, and hospital-affiliated women's health groups.
One global maternity code carries roughly ten months of care. The moment a patient changes insurance in the second trimester, transfers in at 28 weeks, or delivers with another group, that code stops working and the episode has to be rebuilt out of antepartum, delivery and postpartum parts. Most practices rebuild it late, or write it off. Meanwhile the ultrasound component, the same-day well-woman visit and the contraceptive device sit on the claim mispriced or missing.
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OBGYN medical billing services cover coding, claim submission, denial work and AR follow-up for obstetric and gynecologic care, from the global maternity package and obstetric ultrasound to in-office procedures and contraceptive devices. Across 38 Luxen client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days of onboarding.
OB/GYN is two billing problems in one practice. The obstetric side runs on episode logic: a single global code such as 59400 or 59510 stands in for ten months of care, and it only holds while one group provides all of it. The gynecologic side runs on visit-and-procedure logic, where a preventive exam, a problem visit, a colposcopy and a device can land on the same date of service.
We bill for solo gynecology offices, multi-provider OB/GYN groups, certified nurse-midwife and birth center practices, maternal-fetal medicine, and hospital-affiliated women's health groups. Provider type changes the math: Medicare pays certified nurse-midwife services at 100% of the physician fee schedule amount, nurse practitioners and clinical nurse specialists at 85%.
Most groups also bill outside the office note: obstetric ultrasound with split professional and technical components, surgical cases carrying 90-day global periods, cytopathology paid under the clinical laboratory fee schedule rather than the physician fee schedule, and contraceptive devices bought by the practice and billed as supply codes. Each has its own denial pattern.
Dollar figures are CY2026 Medicare Physician Fee Schedule national non-facility amounts, computed from published CMS relative value units at the CY2026 conversion factor of $33.4009. Commercial and Medicaid rates differ; the relative size of each leak does not.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Patient transfers in or out mid-pregnancy | 59400, 59425, 59426, 59430 | Full global billed for partial care, or partial care never billed | $574.83 on 59425 alone | Global maternity billing errors appeared on 12% of deliveries where the patient changed practices |
| Ultrasound done in a facility, read by the practice | 76805, 76811, 76817 with modifier 26 or TC | Global billed when the practice owns only the professional component | $88.85 recouped on the 76805 technical component | Ultrasound frequency denials made up 9% of OB denials |
| Well-woman exam and a problem visit on one day | 99214, G0101, Q0091, modifier 25 | Modifier 25 missing, so the problem E/M bundles into the preventive service | $135.61 on the 99214 | Modifier 25 was missing on 13% of well-woman visits billed with a same-day problem E/M |
| IUD or implant inserted in the office | 58300, 11981, J7297, J7298, J7307 | Insertion billed, device supply code and NDC left off | $107.55 on 11981 before the device | Contraceptive device J-codes were missing from 15% of IUD and implant insertion claims |
| Screening Pap and pelvic on the wrong interval | G0101, Q0091 | Low-risk Medicare patient billed annually against a 24-month interval | $85.84 across both codes | Eligibility and coverage errors caused 24% of denials |
CMS carries every maternity code with the global surgery indicator MMM, meaning the usual global period does not apply. The CMS National Correct Coding Initiative Policy Manual, Chapter 7, states that the total obstetrical packages such as 59400 and 59510 include antepartum care, the delivery, and postpartum care. The same language appears in the Medicaid NCCI Policy Manual, so the rule is not Medicare-only.
Bundled into the delivery codes and not separately reportable: 59050 and 59051 fetal monitoring during labor, 59300 episiotomy, and 59414 delivery of placenta. Antepartum care includes urinalysis, which is also not separately reportable. Our certified coding team works this list case by case rather than trusting an encounter template.
The package only holds when one practice provides all three components. State Medicaid programs publish the ladder for partial care, and commercial payers largely mirror it. Colorado requires four or more prenatal visits before a global code applies at all, and Washington sets out the same split.
| Care actually provided | How it is billed | CY2026 national non-facility |
|---|---|---|
| 1 to 3 antepartum visits | E/M per visit, with the state modifier where required | Varies by E/M level |
| 4 to 6 antepartum visits | 59425, one unit, dated to the last antepartum visit | $574.83 |
| 7 or more antepartum visits | 59426, one unit, dated to the last antepartum visit | $1,055.47 |
| Delivery only, vaginal | 59409 | $721.79 |
| Delivery plus postpartum, vaginal | 59410 | $976.31 |
| Postpartum care only | 59430, one per patient per pregnancy | $261.20 |
Services that stay outside the package entirely, per NCCI Chapter 7: ultrasound, amniocentesis, genetic screening, visits for conditions unrelated to the pregnancy, and additional frequent visits driven by a high-risk condition. Practices that bill 59400 and stop leave every one of those on the table. Amniocentesis, code 59000, carries its own 000-day global period in the CY2026 fee schedule, which is CMS confirming in a second place that it sits outside the maternity package.
Every obstetric ultrasound code in the 76801 to 76821 family carries CMS PC/TC indicator 1, which means both a professional and a technical component exist and modifiers 26 and TC apply. Which one you bill depends on who owns the machine and who wrote the interpretation. The Medicare Claims Processing Manual, Chapter 13, is explicit: for hospital inpatients the technical component is inside the facility payment and cannot be billed separately, while in non-hospital settings it is paid under the fee schedule.
| Code | Global | Professional (26) | Technical (TC) |
|---|---|---|---|
| 76816 follow-up, per fetus | $111.22 | $40.75 | $70.48 |
| 76805 after 14 weeks, single fetus | $135.94 | $47.10 | $88.85 |
| 76811 detailed, single fetus | $182.03 | $90.52 | $91.52 |
| 76815 limited | $81.50 | $30.73 | $50.77 |
| 76817 transvaginal obstetric | $92.85 | $35.40 | $57.45 |
| 76818 biophysical profile with NST | $121.91 | $50.10 | $71.81 |
| 59025 fetal non-stress test | $50.44 | $29.39 | $21.04 |
First-trimester scanning follows the same split: 76801 pays $116.90 globally and $46.43 for the professional component. Note that 76802, 76810 and 76812 carry global indicator ZZZ. CMS defines ZZZ as a code related to another service that is always included in the global period of that other service, so those additional-fetus codes only report alongside their base code.
There is no national Medicare frequency cap on obstetric ultrasound, because Medicare pays for almost no deliveries. The limits that actually deny your claims are at state level. Washington covers one ultrasound at week 13 or earlier, one at weeks 16 through 22, and others only when medically necessary, which is why our Washington billing team checks gestational age before submission. Colorado covers a maximum of two ultrasounds for a low-risk pregnancy. Our North Carolina team works to a different rule again: three fetal non-stress tests are covered in a 280-day period before a high-risk diagnosis must appear on the claim, and requires at least 26 weeks gestation for 59025 and for the biophysical profile codes.
NCCI Chapter 1 draws the line most OB/GYN practices get wrong. The decision to perform a minor procedure is already paid inside that procedure and cannot be billed as a separate E/M. But a significant, separately identifiable E/M unrelated to that decision is separately reportable with modifier 25. Minor here means the 000 and 010 day global periods, which covers 58100 endometrial biopsy, 57454 colposcopy with biopsy and curettage, 58301 IUD removal and 11981 implant insertion. Modifier 57 is different: it applies only to major 090-day procedures such as 58565 hysteroscopic sterilization, and only to the decision-for-surgery visit.
Modifier 33 flags a preventive service, defined in CMS Transmittal 3232 as one whose primary purpose is delivery of a service carrying a USPSTF A or B rating or another preventive mandate. The cost-sharing rule sits in 45 CFR 147.130: bill the preventive service separately from the office visit and cost sharing may be applied to the visit; do not bill it separately, and where the visit's primary purpose was the preventive service, no cost sharing may be applied at all. Getting that wrong creates a patient balance that should never have existed, which is why we run benefit checks before the appointment.
Medicare frequency for G0101 and Q0091 is every 24 months at routine risk and every 12 months at high risk, with high-risk criteria set in NCD 210.2. Medicare waives the deductible and coinsurance when coverage conditions are met. HPV screening with a Pap for ages 30 to 65 is covered once every 5 years.
On devices, 58300 carries CMS status N, non-covered, as do J7297, J7298, J7300 and J7301, with J7307 not valid for Medicare purposes. That is a Medicare fact, not a billing fact. Medicaid and commercial plans pay, and the device is billed separately from the insertion with its own HCPCS code and NDC. CMS recommended that unbundling to state Medicaid programs in its April 2016 bulletin on long-acting reversible contraception.
CMS NCCI Chapter 7 says the opposite. The packages exclude ultrasound, amniocentesis, genetic screening, visits for unrelated conditions, and additional frequent visits driven by a high-risk condition. Source: CMS NCCI Policy Manual Chapter 7 (2026). One missed detailed anatomy scan is $182.03 at the CY2026 national non-facility rate. Ultrasound frequency denials made up 9% of OB denials in our claim audit.
CMS carries 58300 with status indicator N, non-covered, and J7297, J7298, J7300 and J7301 the same way. Source: CMS status indicators. Medicaid and commercial plans do pay, and they want the device supply code with an NDC alongside the insertion. Leaving it off means absorbing the acquisition cost. Contraceptive device J-codes were missing from 15% of IUD and implant insertion claims we audited.
NCCI Chapter 1 permits a significant, separately identifiable E/M with modifier 25 where it is unrelated to the decision to perform the minor procedure. Source: CMS NCCI Policy Manual Chapter 1 (2026). At $135.61 for a 99214 the annual cost of not billing it runs into five figures. Modifier 25 was missing on 13% of well-woman visits billed with a same-day problem E/M.
Only the physician interpretation does. CMS carries 88141 as status A, while 88142 through 88175 and 87624 and 87625 carry status X, a statutory exclusion, and are paid under the clinical laboratory fee schedule. Source: CMS Physician Fee Schedule CY2026 data. Practices posting these to the wrong fee schedule chase variances that were never variances. Underpayments against contracted rates appeared on 7.8% of paid claims we audited.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
OB/GYN practices run more systems than most specialties, because the prenatal flowsheet, the ultrasound report and the surgical note rarely live in one place. We work inside Epic, Oracle Health, eClinicalWorks, NextGen, Greenway Intergy, Practice Fusion and DrChrono, alongside the obstetric reporting systems feeding them: GE ViewPoint 6, AS Software OB/GYN reporting, PeriGen and OBiX.
Nothing migrates. We work in the system you already own, with your templates and your fee schedule, and charges post where your staff expect them. That matters: 38% of practice managers had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch. Our full-service billing team logs into yours.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Figures below come from the Luxen claim audit dataset, 61,400 claims audited between January 2025 and June 2026.
Prenatal, delivery, and postpartum services were not consistently reviewed as one maternity episode. Luxen separated global care from appropriately billable services and recovered $62,800 in one quarter.
Practice Administrator, multi-provider OB/GYN group
Ultrasounds and office procedures were documented in separate parts of the chart, so charges were occasionally missed. Luxen built a daily reconciliation and captured 208 unbilled services worth $39,700.
Billing Director, women’s health practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
The AMA is replacing the global maternity bundle with a framework that reports four distinct phases: antepartum care, labor management, delivery, and postpartum care. The AMA puts it at 35 total codes changed, effective January 1, 2027. Deleted: 59025, 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620 and 59622. New labor management codes 59080 and 59081 report the initial day, straightforward or complex, per day; 59082 and 59083 report subsequent days. Delivery moves to 59431 and 59432 for vaginal delivery without or after a previous cesarean, and 59502 and 59503 for primary and repeat cesarean. Antepartum care is reported per encounter with the appropriate E/M service, and postpartum care with the appropriate subsequent care or E/M code.
Nothing changed in the 59xxx, 76xxx or 58xxx ranges for CPT 2026. The AMA CPT 2026 release covers 288 new codes, 84 deletions and 46 revisions, and names no maternity changes. Any page telling you 2026 rewrote the maternity codes is a year early. What does change in 2026 is payment: CMS finalized a -2.5% efficiency adjustment to work RVUs for non-time-based services, and explicitly exempted maternity codes with a global period of MMM. The CY2026 conversion factor is $33.4009 for non-qualifying APM participants and $33.5675 for qualifying APM participants.
The practical 2026 task is data hygiene. Under the 2027 structure every antepartum visit becomes its own reportable encounter, so practices that have been charting prenatal visits loosely because one code covered them will have twelve months of thin documentation feeding a per-encounter billing model.
Vendor dashboards publish clean claim rates because they flatter. The numbers that predict cash are ageing and rework. Across Luxen client practices, median days in AR dropped from 54 to 33 within 120 days. In practices we review before onboarding, 27% of total AR sat past 90 days and 19% of denied claims were never reworked or appealed. Coding and modifier errors caused 21% of denials in our claim audit; eligibility and coverage errors caused 24% of denials. Both are preventable before the claim leaves.
Appeals filed by Luxen were overturned 68% of the time, and we recovered 61% of the dollar value of claims aged 90 to 180 days that practices had stopped working. That is work most OB/GYN groups do not staff: 42% of practice managers said nobody owns denial follow-up full time. Our denial and AR recovery team starts with the oldest recoverable dollars.
Medicaid paid for 40.2% of the 3,628,934 US births in 2024, per CDC National Center for Health Statistics final data, so Medicaid rules govern the obstetric half of most books. The 12-month postpartum option created by the American Rescue Plan Act was made permanent by section 5113 of the Consolidated Appropriations Act, 2023, and 46 states plus DC and the US Virgin Islands had extended coverage beyond 60 days as of May 2024. That extra year is billable postpartum and contraceptive care most practices never capture, which is why our Colorado billing team tracks coverage span by patient rather than by claim.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges a percentage of what we actually collect, 3% to 6%, set by volume, payer mix and how much of the book is obstetric. At 4.5%, a group collecting $1.8M a year pays $81,000, or $6,750 a month. At 3% that is $54,000; at 6%, $108,000. No separate fee for ultrasound, device or surgical claims, and no setup or exit fee. Across 96 practices that shared payroll data, fully loaded in-house billing cost 7.9% of collections for practices under $2M. On $1.8M that is $142,200 a year.
| Cost line | In-house | Luxen at 4.5% |
|---|---|---|
| Biller salaries, payroll taxes and benefits | $96,000 | Included |
| Certified coding, OB episodes and GYN surgery | $22,000 | Included |
| Clearinghouse, scrubbing and reporting tools | $9,200 | Included |
| Denial, appeal and AR follow-up capacity | $15,000 | Included |
| Total annual cost | $142,200 | $81,000 |
| Annual difference | $61,200 |
The percentage is not the whole return. Every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year, and practices lost 3.1% of collections to patient balances written off before a second statement, which is why patient billing sits inside the same percentage rather than beside it.
Ask how they handle a patient who transfers in at 28 weeks, and listen for 59425 and 59426 rather than a general answer about global packages. Ask whether they bill your ultrasounds globally or split by component, and how they decide. Ask what their plan is for January 1, 2027. Ask for the fee basis in writing: 44% of practice managers could not name the fee basis in their current billing contract. Ask who owns denial follow-up by name, because 52% of practices that switched billing vendors cited missing denial reporting as the main reason.
Coding, submission, denials, appeals, AR, patient balances and payer credentialing in one scope. Credentialing is not optional here: a lapsed re-credentialing held payments for a median of 47 days in the practices we reviewed. If you are still shortlisting, compare medical billing companies by state first.
| Partner type | OB/GYN depth | Denial work | Typical cost |
|---|---|---|---|
| In-house biller | Whatever that one person learned | Stops during leave | 7.9% of collections |
| Generalist billing company | Templates across 30 specialties | Oldest claims dropped | 4% to 8% of collections |
| Specialty billing company | Deep, if the specialty is truly theirs | Usually structured | 3% to 7% of collections |
| EHR vendor RCM arm | Tied to their software, migration expected | Tickets, not owners | 4% to 9% of collections |
| Luxen | OB episodes, ultrasound components, GYN surgery, devices | Oldest recoverable dollars, named owner | 3% to 6% of collections |
Month to month, 30 days notice, no setup fee, no exit fee. A BAA is signed before anyone touches your data, and our coders are certified.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
CMS NCCI Chapter 7 states that the total obstetrical packages such as 59400 and 59510 include antepartum care, the delivery, and postpartum care. Fetal monitoring during labor (59050, 59051), episiotomy (59300), delivery of the placenta (59414) and antepartum urinalysis are bundled in. Ultrasound, amniocentesis, genetic screening and visits for conditions unrelated to the pregnancy stay outside the package and are billed separately.
Luxen charges 3% to 6% of collections, set by volume, payer mix and how much of your book is obstetric. For a three-provider group collecting $1.8M a year, 4.5% is $81,000 against $142,200 for fully loaded in-house billing at the 7.9% of collections we measured across 96 practices under $2M. No setup fee, no exit fee, no separate charge for ultrasound or device claims.
About two weeks from signed BAA to working claims, and first recovered payments in about three weeks. Median time from signed BAA to first claims worked was 9 business days across our client practices. We start on the oldest recoverable dollars, because we recovered 61% of the dollar value of claims aged 90 to 180 days that practices had stopped working.
No. We work inside Epic, Oracle Health, eClinicalWorks, NextGen and Greenway Intergy, alongside the obstetric reporting systems that feed them, including GE ViewPoint 6 and PeriGen. Nothing migrates. Practices that switch systems pay for it: among those that had changed in the past five years, 71% said collections dipped for at least six months afterward.
You bill the care you actually provided, not a global code. For 4 to 6 antepartum visits, report 59425 as one unit dated to the last antepartum visit; for 7 or more, report 59426 the same way. Fewer than four visits are billed as individual E/M services with the state modifier where required. Global maternity billing errors appeared on 12% of deliveries where the patient changed practices in our audit.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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