Maternity Care Billing and Coding Tips

​Global maternity care reporting services include maternity care and delivery codes related to antepartum care, admission to the hospital for labor and delivery, management of labor (including fetal monitoring), delivery and postpartum (uncomplicated) care until six weeks postpartum. A global charge should be billed for maternity claims when all maternity-related services are provided by the same physician or physicians within the same group. Individual Evaluation and Management (E&M) codes should not be billed to report maternity visits. Prenatal care is considered part of the global reimbursement and is not reimbursed separately.

Prenatal, Delivery and/or Postpartum Services Billed Separately Only When Transfer of Care Occurs

• 59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care 59610
• Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/ or forceps) and postpartum care, after previous cesarean delivery 59618
• Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery 59510
• Routine obstetric care including antepartum care, cesarean delivery, and postpartum care Obstetrics Coding and Documentation Reference Guide Global maternity care reporting services include maternity care and delivery codes related to antepartum care, admission to the hospital for labor and delivery, management of labor (including fetal monitoring), delivery and postpartum (uncomplicated) care until six weeks postpartum

A global charge should be billed for maternity claims when all maternity-related services are provided by the same physician or physicians within the same group. Individual Evaluation and Management (E&M) codes should not be billed to report maternity visits. Prenatal care is considered part of the global reimbursement and is not reimbursed separately.

The CPT manual identifies and describes the following codes as global maternity services: The following are instances where it is appropriate to submit a claim separately for prenatal, delivery and/or postpartum services:

• When the member’s coverage started after the pregnancy started • When the member’s coverage terminates before the delivery
• When the pregnancy does not result in a delivery
• When another provider in a different location takes over care of the member before completion of the global services
• When, during the member’s pregnancy, there is a change in the member’s benefits Maternity Service Number of Visits CPT Coding Antepartum Care Only 1-3 visits Use E&M Codes Antepartum Care Only 4-6 visits 59425 Antepartum Care Only 7 or more visits 59426 Postpartum Care 59430 This Quick Reference Guide is for informational purposes only.

Providers should reference the Current Procedural Terminology (CPT®) manual for the most current updates and for any additional maternity related service codes. The most current codes should be submitted on a claim. Member eligibility and benefits should be determined before medical guidelines and reimbursement guidelines are applied. If a provider in a different practice provides the prenatal and/or postpartum care but does not handle the delivery, the delivering provider can file a claim using the antepartum/postpartum care only codes according to how many times the provider sees the patient.