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

In Mississippi, the way obstetric (OB) care is billed is changing fast. For years, most providers used the “global” model, a single CPT code (such as 59400) that wrapped together prenatal visits, delivery, and postpartum care. But today, Medicaid and several commercial payers in the state are moving toward an unbundled approach, requiring each stage of maternity care to be billed separately. 

Mississippi’s Medicaid program, through its MOMS initiative, has already set clear rules for billing postpartum visits outside the global package, while private insurers are also phasing out reimbursement for traditional global codes. These changes are reshaping how OB practices in the state handle documentation, claims, revenue cycles, and compliance, pushing providers to adapt to a new era of maternity billing.

Why Unbundled OB Billing in Mississippi?

The move toward unbundled OB billing in Mississippi stems from a mix of state Medicaid reforms and payer-driven changes aimed at improving transparency, fairness, and accuracy in maternity care reimbursement.

State Medicaid Policy Shifts

Mississippi Medicaid has taken a lead role in reshaping how obstetric services are reimbursed. Under its MOMS (Mississippi Obstetric and Maternal Services) initiative, the state moved away from global billing because the bundled model often masked the true scope of care. By requiring providers to bill antepartum, delivery, and postpartum services separately, Medicaid can:

• Track each component of maternity care more precisely.
• Support continuity of care when patients transfer between providers or delivery settings.
• Streamline reimbursement processes for managed care organizations that must account for multiple episodes of care.

For example, postpartum visits outside the global package can now be billed separately with the appropriate modifier, ensuring providers are fairly compensated for care delivered beyond the standard bundle.

Managed Care and Commercial Trends

Mississippi’s shift is also tied to broader payer dynamics. Managed Medicaid plans and some commercial insurers found the global model problematic, particularly when patients switched physicians mid-pregnancy. Disputes over which provider should bill under a global package often result in delayed or reduced payment.

How Unbundled OB Billing Works?

The shift from the global package to unbundled billing changes how each stage of maternity care is coded and reimbursed, as outlined below.

Traditional Global Model

In the past, most obstetric care was billed under a single “global” CPT code (such as 59400), submitted after the pregnancy concluded. This one code covered all routine prenatal visits, the delivery itself, and postpartum follow-up. Regardless of how many visits occurred or whether multiple providers were involved, payment came as a single lump sum.

Current Unbundled Model

With unbundled billing, each stage of maternity care is billed on its own. This approach uses distinct codes for different parts of the pregnancy and delivery process:

• Antepartum Care: Either individual E/M codes for each visit, or specific “partial antepartum” codes 59425 for 4 - 6 visits, and 59426 for 7 or more visits. In some programs, billing is required by date of service.
• Delivery Only: 59409 for a vaginal delivery, 59514 for a cesarean delivery, or other specialty delivery codes such as those for VBAC.
• Delivery + Postpartum: 59410 or 59515 when the same provider manages both the delivery and the postpartum period.
• Postpartum Only: Stand-alone postpartum visits are billed either with E/M codes or with 59430, if not already included in a bundled arrangement.

State Variations: Mississippi as a Case Study

In Mississippi, OB practices that once billed under the global code 59400 quickly realized their claims were no longer being paid. Medicaid had stopped reimbursing for bundled maternity codes, forcing providers to change their billing approach.

The Clinic Challenge

A women’s health clinic in Jackson experienced repeated denials when using global codes. This disruption pushed them to explore unbundled billing and re-train their staff on new claim processes.

Adapting to Unbundled Billing

The clinic began billing each prenatal visit separately with E/M codes, submitting delivery claims with 59409 (vaginal) or 59514 (cesarean), and billing postpartum visits using 59430 or E/M office codes.

Mississippi CAN Requirements

For patients covered under the Coordinated Access Network (CAN), the rules were even stricter. Partial antepartum codes 59425 (4–6 visits) and 59426 (7+ visits) had to be billed by the date of service, providing Medicaid with a more detailed record of care.

Role of Modifiers

Correct modifier use also became essential. For example, the “TS” modifier flagged timely postpartum visits in value-based programs, ensuring providers received proper credit and reimbursement.

Key Takeaway

While the transition felt overwhelming at first, Mississippi’s unbundled model created more transparency. Providers were paid fairly for each service delivered, and disputes over global billing quickly declined.

Commercial Payer Differences

While Medicaid in Mississippi has firmly moved toward unbundled billing, many commercial insurers still follow the global model with important exceptions when care is shared or transferred.

Global Billing Still Common

Many commercial insurers, such as Cigna, Aetna, and Blue Cross Blue Shield (BCBS) Mississippi, continue to reimburse maternity care using global OB codes. However, they often require unbundled billing when the episode of care is shared or transferred between providers.

When Only Part of Care Is Provided

If a physician handles just one part of the pregnancy, for example, only the delivery, they must bill only that portion using the appropriate delivery-only code.

Patient Transfers Mid-Pregnancy

When a patient switches practices, both providers are expected to bill only for the services they actually performed. This typically involves using partial antepartum codes for prenatal visits and delivery-only codes for the birth.

Emerging Payment Models

Some commercial payers are experimenting with per-visit reimbursement within value-based pilots. Even in systems that traditionally relied on global payments, these models are designed to give more flexibility and better align payments with the care delivered.

Impact on Practices

The shift from global to unbundled billing doesn’t just change how claims are filed; it reshapes the daily operations of OB practices. As seen in the Mississippi case study, providers must now balance new billing requirements with the realities of patient care, financial planning, and regulatory compliance.

Documentation: From Routine Notes to Audit-Proof Records

Every encounter must now be tied to the exact service provided. For prenatal care, this means specifying not just “routine visit” but the exact scope of evaluation and management. Delivery claims require supporting details such as delivery type, complications, or transfer of care. Robust documentation protects against denials and demonstrates medical necessity if an audit occurs.

Revenue Cycle: Shifting Cash Flow Dynamics

Global billing once delivered a predictable, lump-sum payment. With unbundling, revenue comes in fragments with each prenatal visit, delivery, and postpartum service generating its own claim. For practices, this can slow down cash flow and increase the volume of claims staff must manage. Strong revenue cycle management systems, regular reconciliation, and payer follow-up become essential to avoid gaps in income.

Audit Readiness: Higher Scrutiny, Higher Stakes

Because payers receive more claims under unbundled models, they apply more scrutiny to ensure accuracy. Practices should anticipate audits focusing on visit frequency, modifier use, and justification for billed services. A compliance-first mindset, periodic internal audits, staff training, and coding accuracy checks help minimize risk and maintain payer trust.

Patient Communication: Setting Expectations Early

Patients may also feel the impact. Instead of one “global” charge, they see multiple line items on Explanation of Benefits (EOBs) and billing statements. Without clear communication, this can cause confusion or mistrust. Successful practices are those that educate patients up front, explaining why separate charges appear and reassuring them that the total cost of care is comparable to the global model.

Best Practices for Success

Moving from global to unbundled billing can feel overwhelming at first, but the right strategies help practices stay compliant and protect revenue. Here are some proven approaches:

Verify Insurance Rules Early

Every payer has its own policies. Before the first claim is filed, confirm the billing requirements for a patient’s insurance plan. This becomes especially important when patients change coverage mid-pregnancy, as global codes may not transfer across insurers.

Invest in Billing Team Training

Accurate coding is the backbone of successful unbundled billing. Train billing staff to choose the correct CPT codes and apply the right modifiers for each scenario, whether it’s split care, postpartum-only services, or delivery-only claims.

Stay Ahead of Policy Updates

Medicaid programs and commercial insurers regularly adjust their payment rules. Build a system for tracking payer bulletins and annual updates so your team can adapt quickly when reimbursement models shift.

Strengthen Documentation Standards

Granular billing attracts more scrutiny from payers. Each encounter note should clearly describe the service provided and justify the CPT code used. Strong documentation not only supports claims but also protects your practice in the event of an audit.

Why OBGYN Practices Trust BillingFreedom for Unbundled Billing Success

The transition from global to unbundled OB billing has changed the way practices handle claims, compliance, and patient communication. From Medicaid rules in Mississippi to commercial payer variations, providers now face stricter documentation requirements, increased audit scrutiny, and shifting revenue cycles. Without the right systems in place, these changes can quickly lead to denials and cash flow challenges.

At BillingFreedom, we turn these complexities into streamlined solutions. Our OBGYN medical billing experts stay ahead of payer policy updates, apply accurate CPT codes and modifiers, and build audit-ready documentation workflows. We help practices reduce compliance risks, accelerate reimbursements, and maintain transparency with patients through clean, accurate billing. 

With BillingFreedom as your trusted partner, unbundled OB billing doesn’t have to be a burden; it becomes a pathway to stronger financial health and better patient care.

For more details about our exceptional OB/GYN 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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