OB-GYN BILLING

AI-Powered OB-GYN Billing & RCM

Global maternity packages, antepartum/postpartum splits, and ultrasound bundling built for OB-GYN's episode-of-care billing, not generic office-visit billing.

THE PROBLEM

A pregnancy is one episode of care, billing rarely treats it that way.

Global maternity package (59400/59510/59610/59618) billed as separate visits, losing bundled reimbursement or triggering duplicate-billing denials
Antepartum care not split correctly (59425/59426) when a patient transfers practices mid-pregnancy
Multiple OB ultrasounds billed without payer-specific frequency and bundling rules
Well-woman preventive visits billed without modifier 25 when a separate problem is addressed the same day

Sterling tracks the pregnancy episode, not just the visit.

Our AI is tuned to OB-GYN's bundled-care billing logic, not a generic office-visit filter.

Global maternity components verified against payer bundling rules before submission
59425/59426 antepartum-only billing applied correctly on transfer-of-care cases
Ultrasound frequency and bundling (76801–76816) checked against payer-specific limits
Modifier 25 applied on well-woman visits only when documentation supports it
WHERE THE MONEY LEAKS

The bundling rules that decide reimbursement.

OB-GYN is one of the specialties our founder has personally billed for 8+ years, the bundling logic below is built from that hands-on experience, not a generic rule set.

🀰

Global Maternity Package Billing

CPT 59400 (vaginal), 59510 (cesarean), 59610/59618 (VBAC) bundle antepartum, delivery, and postpartum care under one global fee, billing components separately is one of the most common denial triggers.

global maternity
πŸ”€

Antepartum & Transfer-of-Care Billing

CPT 59425 (4–6 visits) and 59426 (7+ visits) apply when a patient transfers care mid-pregnancy; 59430 covers postpartum-only care.

59425/59426
πŸ–₯️

OB Ultrasound Bundling

First-trimester (76801–76802), standard (76805–76810), and detailed anatomy (76811–76812) ultrasounds carry payer-specific frequency and bundling rules generalist billers miss.

76801–76816
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Well-Woman vs. Problem Visit

Preventive well-woman exams billed alongside a separately identifiable problem need modifier 25 and matching documentation, or the E/M gets bundled into the preventive visit.

modifier 25
HOW WE WORK YOUR CLAIMS

Built for OB-GYN's bundled-care billing.

01
βœ…

Verify

Eligibility, global-package enrollment, and prior ultrasound/visit history confirmed before the encounter.

02
πŸ”

Scrub

Global maternity components, antepartum split billing, and ultrasound frequency rules validated against payer policy.

03
πŸ“„

Document

Modifier 25 support, transfer-of-care documentation, and gestational-age-specific ultrasound indications attached before submission.

04
πŸ’°

Collect

Clean claims submit same-day; global-package and bundling denials get root-cause analysis by claim type.

FAQ

What OB-GYN practices ask first.

How does global maternity billing work?
CPT 59400 (vaginal delivery) and 59510 (cesarean) bundle routine antepartum care, the delivery, and postpartum care into one global fee. Billing the components separately when they're covered by the global package is one of the most common OB-GYN denial triggers.
What if a patient transfers practices mid-pregnancy?
Antepartum-only care is billed with CPT 59425 (4–6 visits) or 59426 (7+ visits) instead of the global package, and postpartum-only care with 59430, when the delivering provider is different from the one who provided antepartum care.
How many ultrasounds can you bill during a pregnancy?
It depends on the payer. First-trimester (76801–76802), standard second/third-trimester (76805–76810), and detailed anatomic survey (76811–76812) ultrasounds each carry their own frequency and medical-necessity rules, and payers vary on how many they'll reimburse without extra justification.
Do you bill well-woman visits and problem visits together?
Yes, when the documentation supports it. A separately identifiable problem addressed during a preventive well-woman exam needs modifier 25 on the E/M code, backed by documentation distinguishing it from the preventive service.
What EHR systems do you work with for OB-GYN practices?
We work inside the EHR and practice management system your practice already uses.

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πŸ€–Sterling AI AgentOnline Β· instant answers