OBGYN Billing Services

Why Is the Global Obstetric Payment Model Being Eliminated?

The global obstetric package, in place since the 1990s, bundles all prenatal visits, delivery, and postpartum care into a single payment regardless of how many visits, how complex the pregnancy, or how many providers were involved. ACOG spent years advocating for its elimination because this model no longer reflects how obstetric care is actually delivered: multidisciplinary teams of OBGYNs, certified nurse midwives, laborists, and maternal-fetal medicine specialists now routinely share care across antepartum, labor, delivery, and postpartum phases, and a single bundled code cannot capture that division of work.

Beginning January 1, 2027, all 17 legacy global codes will be deleted, replaced by 12 new codes reporting each phase separately. This is not a minor annual coding update; it is a restructuring of how nearly every OBGYN practice in the country gets paid for maternity care.

What Should a Practice Be Doing Right Now, Before 2027?

ACOG recommends that practices begin billing antepartum visits using standard E/M codes (99202 to 99499) with the HCPCS modifier TH appended to identify them as maternity-related, starting no later than September 1, 2026. This transition matters immediately because patients who begin antepartum care in 2026 but deliver after January 1, 2027, need their visits billed consistently across both the old and new systems, and a practice that waits until January 2027 to test payer acceptance of the new billing approach risks weeks of claim rejections during the changeover.

By the fourth quarter of 2026, a practice should already be testing TH modifier acceptance with its top payers, training billing staff on individual E/M coding for antepartum visits rather than relying on the global package, and updating EHR templates to support both billing models simultaneously during the transition window.

Why Do VBAC Claims Have the Highest Denial Rate in Obstetric Billing?

CPT 59618, the code for attempted vaginal birth after cesarean, carries the highest denial rate in the maternity billing category. Without explicit documentation of the conversion, whether the attempt succeeded as a VBAC or converted to a cesarean, payers frequently reclassify the claim to CPT 59510, the cesarean global code, which pays at a lower contracted rate. This price differential runs 180 to 420 dollars per delivery, which translates to an estimated 54,000 to 126,000 dollars annually for a practice managing 300 deliveries a year.

This is a particularly costly gap because it functions as a silent underpayment rather than a formal denial. The claim gets paid, just at the wrong rate, which means it never appears on a standard denial report. Catching it requires actively comparing contracted rates against actual payments by CPT code and payer, not simply reviewing which claims were rejected.

Why Does Co-Management Billing Between an OB and MFM Specialist Cause Denials?

When a maternal-fetal medicine specialist co-manages a pregnancy alongside the attending OBGYN, correct billing requires modifier 54 on the attending physician’s claim and modifier 55 on the co-managing specialist’s claim. Omitting either modifier triggers a payer’s duplicate-claim edit logic, which can deny one or both claims since the system reads two providers billing the same global code as a duplicate rather than a legitimate split of care.

This has become a more active area of payer scrutiny in 2026 specifically, even though the global maternity codes themselves were exempted from that year’s broader RVU efficiency cuts. The fee schedule protection does not extend to claim-level edit logic, which means denial rates on co-managed pregnancies can rise even while the underlying reimbursement rate stays flat.

What Happens When a Patient Transfers Care Mid-Pregnancy?

When a patient transfers between providers during pregnancy, both the transferring and receiving provider need to bill using antepartum-only codes reflecting the actual number of visits each one provided, rather than either side submitting a full global code. Incomplete documentation of exactly how many antepartum visits occurred before a transfer is a common cause of denials for both providers involved, since payers cannot verify that the total billed care matches what was actually delivered without a clear visit count on both sides of the transfer.

Maintaining a visit count log in the patient chart, and communicating exact visit numbers at the point of transfer, is what prevents this from becoming a denial on both ends of the same pregnancy.

What Is Included in Zeerak Care’s OBGYN Billing Services?

Zeerak Care manages global maternity package billing under the current structure while actively preparing for the 2027 itemized model, applies modifier 54 and 55 correctly for co-managed pregnancies, and documents VBAC conversions explicitly to prevent silent reclassification to the lower-paying cesarean code. This coordinates with medical coding services for the phase-based coding structure taking effect in 2027, and with denial management services for the specific edit-logic denials this specialty produces.

Why Choose Zeerak Care?

Zeerak Care is actively preparing OBGYN clients for the 2027 maternity coding transition while managing current global package billing with the modifier precision and documentation standards that prevent silent underpayments like VBAC reclassification. We deliver this at 40 to 50 percent lower cost than many U.S. billing firms, with the specialty depth to catch revenue gaps that do not show up on a standard denial dashboard.

Frequently Asked Questions

What is changing with obstetric billing in 2027?

Effective January 1, 2027, the AMA is eliminating the traditional global obstetric payment model, deleting 17 codes and replacing them with 12 new codes that report antepartum, labor management, delivery, and postpartum care separately instead of as one bundled payment.

What should OBGYN practices do before the 2027 transition?

ACOG recommends billing antepartum visits with standard E/M codes and the TH modifier starting no later than September 1, 2026, and testing payer acceptance of this approach well before the January 2027 deadline to avoid claim disruptions.

Why does CPT 59618 (attempted VBAC) have the highest denial rate in obstetric billing?

Without explicit documentation of whether the VBAC attempt succeeded or converted to a cesarean, payers often reclassify the claim to the lower-paying cesarean code, CPT 59510, a silent underpayment that can cost a 300-delivery practice 54,000 to 126,000 dollars annually.

How should co-management between an OB and MFM specialist be billed?

The attending OB’s claim requires modifier 54 and the co-managing MFM specialist’s claim requires modifier 55. Omitting either modifier triggers a payer’s duplicate-claim edit logic, which can deny one or both claims.

Why do transfer-of-care claims get denied for both providers?

When a patient transfers mid-pregnancy, both providers must bill antepartum-only codes reflecting their actual visit count rather than a full global code. Incomplete documentation of visit numbers on either side is a common cause of denial for both the transferring and receiving provider.

Are global maternity codes affected by the broader 2026 Medicare RVU cuts?

No. CMS explicitly exempted global maternity packages from the 2026 RVU efficiency reduction, though this protects only the fee schedule amount, not the claim-level denial and edit scrutiny that has intensified separately.

Prepare for the Biggest Change in Obstetric Billing in Decades

If your practice needs to prepare for the 2027 maternity coding transition, or is losing revenue to VBAC reclassification and co-management denials today, Zeerak Care can help. Our OBGYN billing services are built around both the current global package structure and what comes after it.