OB Global Billing. Guidelines for California OB/GYNS

Global billing for pregnancy is designed to simplify the process of charging for comprehensive obstetrical care throughout the entire pregnancy. This method encompasses all essential components, including antepartum services, delivery, and postpartum follow-up, within a single comprehensive claim. It also extends to hospital admissions, medical history, examinations, labor supervision, hospital discharge, and necessary postoperative management. By offering a structured approach, global billing ensures that providers can manage documentation and reimbursement efficiently while delivering consistent, high-quality maternal healthcare.

Global Billing Policy for Obstetrical Care

The purpose of global billing (CPT codes 59400, 59610, and 59618) is to provide a convenient option for providers delivering total obstetrical care throughout pregnancy. Global obstetrical (OB) billing includes antepartum care, delivery, and postpartum services. It also covers hospital admission, patient history, physical examination, labor management, postpartum office visits, vaginal or cesarean delivery, delivery after previous cesarean, hospital discharge, and all necessary postoperative care.

Requirement of 13 Antepartum Visits for Global Billing

To qualify for global obstetrical billing, providers must complete a minimum of 13 antepartum OB visits, which must be documented either in the Remarks field (Box 80), the Additional Claim Information field (Box 19), or attached to the claim for reimbursement. The initial comprehensive pregnancy-related office visit is not included in these 13 visits. If fewer than 13 visits are provided, billing must be done on a per-visit basis. Global billing cannot be used for patients who have transferred care after receiving obstetrical services from another Medi-Cal provider.

Non-Reimbursable Services Under Global OB Billing

Providers who choose the global billing option cannot separately bill for antepartum or postpartum visits, except for the Medi-Cal initial antepartum visit (Z1032). The following services are not reimbursable when included in global billing:

• Antepartum visits (Z1034) by the same provider, within the global billing period or 270 days prior to the delivery date.
• Hospital visits during the covered period.
• Postpartum visits (Z1038) for routine follow-up care within 45 days after delivery, when billed by the same provider.

Global Obstetrical Billing Codes and Frequency Limits

The following CPT/HCPCS codes are used for global obstetrical billing, each with specific definitions and frequency restrictions:

• 59400 – Global antepartum care, vaginal delivery, and postpartum care (1 in 6 months).
• 59510 – Global antepartum care, cesarean delivery, and postpartum care (1 in 6 months).
• 59525 – Subtotal or total hysterectomy after cesarean delivery (1 in 6 months for subtotal; once in a lifetime for total).
• 59610 – Routine OB care for vaginal delivery, with or without episiotomy and/or forceps, including postpartum care after a previous cesarean delivery (1 in 6 months).
• 59618 – Routine OB care for cesarean delivery and postpartum care following attempted vaginal delivery after a cesarean delivery (1 in 6 months).

Note: Refer to the official CPT code book for detailed procedure descriptions.

From-Through Billing Requirements

Global OB claims (CPT codes 59400, 59510, 59525, 59610, and 59618) must be submitted using the “from-through” billing format on the CMS-1500 form with modifier AG (primary surgeon). The “from” date reflects the first visit of the pregnancy, while the “through” date corresponds to the delivery date.

Verifying Patient Eligibility for Global Billing

For reimbursement of global obstetrical claims, providers are required to confirm the recipient’s Medi-Cal eligibility during the month of delivery.

Transfer of Care in Medi-Cal Pregnancy Cases

When a Medi-Cal patient transfers care, providers must bill each antepartum visit separately, regardless of the number of visits made prior to delivery. In such cases, global billing is not applicable. Providers accepting transfer patients are eligible for reimbursement for all visits provided, within Medi-Cal’s overall limit of one initial comprehensive visit and up to 13 antepartum visits across a nine-month period for all primary obstetrical providers combined.

CMS-1500 Documentation for Cesarean with Tubal Ligation

For global billing of cesarean delivery with tubal ligation, providers must meet specific CMS-1500 documentation requirements. These include:

• Recording the Date of Last Menstrual Period (LMP) in Box 14.
• Entering Hospitalization Dates in Box 16.
• Documenting all 13 antepartum visit dates in the Additional Claim Information field (Box 19).
• Providing primary and secondary diagnosis codes to support both pregnancy and tubal ligation services (Fields 21A and 21B).
• Billing in the “From-Through” format for cesarean delivery (CPT 59510, Field 24A).
• Using modifier AG with CPT code 59510 for global delivery (Field 24D).
• Adding intraoperative tubal ligation CPT code 58611 with modifier 51 (Field 24D).
• Entering Usual and Customary Charges (Field 24F).
• Submit the Sterilization Consent Form (PM 330).

Note: Delivery services performed in an inpatient setting must still be billed using the CMS-1500 form. The physician’s billing details should be listed in Box 33, with the NPI entered in Box 33a.

Expertise in OB/GYN Global Billing Services in California by BillingFreedom

BillingFreedom has extensive experience in navigating the challenges of OBGYN medical billing in California, particularly with global obstetrical billing under Medi-Cal guidelines. By carefully managing requirements such as the 13 antepartum visit rule, from-through billing, and CMS-1500 documentation, our team has consistently delivered measurable outcomes. We have achieved a 97% clean claim rate for OBGYN practices, ensuring providers experience fewer delays, fewer denials, and greater confidence in their reimbursements. 

This reflects our ability to align with state regulations while reducing administrative burdens.

Our results-driven approach has also led to a 92% first-pass resolution rate on OB claims, demonstrating efficiency in handling sensitive areas such as cesarean deliveries, tubal ligation documentation, and transfer of care scenarios. With a proven record of success, BillingFreedom continues to help OB/GYN providers in California focus on delivering patient care while we strengthen their billing performance.

For more details about our exceptional OBGYN billing services in California, 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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