The New Era of Unbundled OB Billing: State and Payer Variations Explained

In recent years, maternity care billing has undergone a fundamental transformation. Where obstetric practices once relied on the simplicity of a single global billing code covering prenatal visits, delivery, and postpartum follow-up, many payers are now dismantling that model. Along with an increasing number of insurers, they are shifting toward itemized billing that separates each stage of care. This evolution is forcing obstetric providers to rethink how they document services, manage clinical workflows, optimize reimbursement, and stay aligned with payer requirements.

Why Did Unbundled OB Billing Emerge?

The move away from global maternity billing did not happen overnight; it reflects specific policy and payer concerns. Two of the most influential drivers behind this shift are outlined below:

State Medicaid Policy Shifts

States such as Mississippi concluded that global OB billing created barriers in both payment accuracy and care coordination. By requiring unbundled billing, Medicaid programs aimed to achieve:

• More precise tracking of each service provided.
• Better alignment with episodes of care that may involve multiple providers or transfers (e.g., split antepartum/delivery).
• Streamlined reimbursement processes for managed care organizations.

Managed Care and Commercial Trends

Many managed Medicaid plans, along with certain commercial insurers, observed that the global model often triggered disputes when patients switched providers during pregnancy. Moving to an unbundled approach helps clarify billing responsibilities and ensures each physician is compensated for the specific care they deliver.

How Unbundled OB Billing Works?

The transition from global maternity billing to an itemized structure represents a significant shift in how obstetric services are reported and reimbursed. Below is a breakdown of the old versus the new approach:

Old (Global) Model

• A single CPT code was submitted at the end of pregnancy to cover all routine antepartum visits, the vaginal delivery, and postpartum care (e.g., 59400).
• Payment was made as a single lump sum, regardless of the number of visits or the number of providers involved in the patient’s care.

New (Unbundled) Model

Each element of maternity care is now billed separately, allowing reimbursement to reflect the actual services delivered:

• Antepartum Visits: Evaluation and Management (E/M) codes per visit, or partial antepartum CPT codes (59425: 4–6 visits; 59426: 7+ visits). In some states/programs, these are billed per date of service.
• Delivery Only: 59409 (vaginal), 59514 (cesarean), or other specialty codes such as for VBAC deliveries.
• Delivery + Postpartum: 59410 (vaginal) or 59515 (cesarean) when the same clinician provides both services.
• Postpartum Only: Office visits billed with E/M codes (if not bundled) or 59430 for a comprehensive postpartum check.

State Variations in Unbundled OB Billing

While the shift away from global maternity billing is gaining traction nationwide, the specific rules vary from state to state. Medicaid programs and managed care organizations often apply their own requirements, making it critical for providers to understand local policies:

• Medicaid Programs: In many states, global maternity codes such as 59400 are not reimbursed. Instead, providers are required to bill antepartum visits individually (often using E/M codes) and submit separate claims for delivery and postpartum care.
• Partial Antepartum Billing: Some programs mandate that codes 59425 (4–6 visits) and 59426 (7+ visits) be billed by date of service rather than as a bundled package, ensuring more precise payment tracking.
• Modifiers: Correct modifier usage (e.g., TS for timely postpartum care in value-based programs) is often required to support compliance and eligibility for reimbursement.
• State-by-State Differences: Policies vary in areas such as how to bill partial antepartum care when fewer than four visits are made. Because of this variation, providers are advised to review state Medicaid bulletins or confirm with managed care plans to ensure proper billing practices.

Commercial Payer Differences

Unlike Medicaid, many commercial insurers still recognize global maternity billing as the standard. However, their policies often shift to an unbundled approach in specific situations, particularly when care is divided between providers. Key considerations include:

• Global Coverage Still Common: Large payers such as Cigna, Aetna, and Blue Cross Blue Shield (BCBS) typically continue to reimburse global OB codes.
• Split or Transferred Care: When a provider delivers only part of the maternity care (e.g., delivery only), they are expected to bill just that component using the appropriate code. Similarly, if a patient changes practices mid-pregnancy, each provider bills only for the services they actually performed, whether partial antepartum care or delivery-only services.
• Emerging Payment Models: Some commercial payers, especially those piloting value-based care programs, are experimenting with per-visit reimbursement even in environments where global billing remains the default.

Impact of Unbundled OB Billing on Practices

The shift to unbundled OB billing affects multiple aspects of obstetric practice operations:

• Documentation: Every patient encounter must be fully documented, clearly specifying the portion of care provided and supporting the CPT code submitted.
• Revenue Cycle: Payments may now arrive incrementally rather than as a single lump sum, which can impact cash flow management.
• Audit Readiness: More granular billing increases scrutiny on visit frequency, medical necessity, and accurate code usage.
• Patient Communication: Patients may receive more itemized statements or EOBs, reflecting multiple maternity-related charges instead of one global fee.

Best Practices for Successful OB Billing

To navigate unbundled billing effectively and maintain compliance, practices should follow these strategies:

• Verify Coverage: Always check the billing requirements for each patient’s insurance, especially when there are mid-pregnancy plan changes or updates.
• Train Billing Staff: Ensure the team selects the correct CPT code and modifier for every scenario, particularly in cases of split care or postpartum services.
• Monitor Payer Updates: Track changes in unbundling rules and allowed amounts, as policies can shift annually for Medicaid programs and commercial pilots.
• Maintain Robust Documentation: Keep detailed records for each billed encounter, especially when care is split, transferred, or medical necessity needs to be demonstrated.

Simplify Unbundled OB Billing with BillingFreedom

Navigating the shift from global OB codes to unbundled billing can feel overwhelming, but at BillingFreedom, we make it manageable. With each antepartum visit, delivery, and postpartum service requiring detailed documentation and precise coding, practices need reliable support to stay compliant and maintain steady cash flow. We understand the challenges OBGYN practices face and provide solutions designed to streamline billing processes, reduce audit risks, and improve revenue cycle efficiency.

By partnering with us, we help practices implement structured workflows, ensure the correct CPT codes and modifiers are used, and stay up-to-date with ever-changing payer rules. Our expertise in OBGYN medical billing services allows you to focus on patient care. At the same time, we handle the complexities of unbundled OB billing, ensuring transparency, accuracy, and financial stability for your practice.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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