Only one specific area has been modified. In 2025, new telehealth CPT codes were introduced; however, the adoption by Medicare remains limited. Being aware of these updates safeguards your revenue and ensures compliance, as improper obstetric global billing consistently ranks among the leading causes of claim denials.
What is a Global Period in OB GYN?
Global-period billing includes prenatal, delivery, and postpartum services consolidated into a single bundled reimbursement for obstetrical care. Instead of billing individually for each prenatal appointment, delivery, and postpartum care, you submit one all-encompassing code that addresses the complete pregnancy experience from the initial prenatal visit to the concluding postpartum examination. The global package typically includes postpartum care for six weeks following delivery, after which additional visits necessitate separate billing.
This is distinct from surgical global periods that utilize specific day counts, such as 10-day or 90-day periods. OB-GYN global billing encompasses the entire range of routine pregnancy care, irrespective of duration.
Core Codes You Need to Know
Global Package Codes
Utilize when your practice provides comprehensive pregnancy care:
- 59510: Cesarean delivery with complete care.
- 59610: Vaginal birth after previous cesarean with complete care.
- 59618: Cesarean after attempted VBAC with complete care.
Component Codes
Utilize when you only manage part of the pregnancy care:
- 59409/59514: Delivery only (vaginal/cesarean).
- 59425: Antepartum care, 4-6 visits.
- 59426: Antepartum care, 7+ visits.
- 59430: Postpartum care only.
Decision Rule:
- Did you only manage certain aspects while other providers took care of different parts? Utilize component codes.
New Telehealth CPT Codes with Limited Medicare Recognition
New CPT codes have been introduced for the year 2025, which include 98000-98007 (audio-video), 98008-98015 (audio-only), and 98016 (brief communication). These codes inherently represent telehealth services and do not necessitate modifier 95. However, Medicare currently acknowledges only 98016; 98000-98015 are not reimbursable by Medicare (although some commercial plans may cover them).
Virtual consultations that are included in standard prenatal or postpartum care continue to be part of the global package. They cannot be billed separately merely because they are performed through telehealth. However, telehealth consultations for complications or issues that fall outside the standard global package may be billed separately using the relevant evaluation and management codes or code 98016 when applicable.
What Did NOT Change?
- CPT codes remain unchanged from 2024.
- Global package regulations have not altered.
- Bundling principles remain consistent.
- The regulations regarding split and shared visits will persist from 2024, upholding the same substantive portion requirements and the use of modifier FS (applicable only to facility settings).
- Services that were eligible for separate billing in 2024 will remain eligible for separate billing in 2025.
Telehealth Rules for 2025
Bundled services will remain bundled irrespective of the delivery method. Routine prenatal telehealth appointments, virtual postpartum check-ups, and standard pregnancy education sessions held online are encompassed within your global package payment.
What Can You Bill Separately?
- Telehealth visits addressing complications.
- Virtual care for unrelated medical issues.
Coding Requirements
Utilize service code 02 for alternative telehealth locations or 10 for a patient’s residence. For traditional E/M codes, most commercial insurers require modifier 95, although Medicare requirements differ by MAC. The recently introduced telehealth CPT codes (98000-98015) do not necessitate the use of modifier 95, as telehealth is inherently encompassed within the code description; nevertheless, it is crucial to highlight that Medicare does not recognize these codes.
Important Note
Medicare’s expanded telehealth flexibilities (including home as the originating site) are effective until September 30, 2025. Code 98016 supersedes HCPCS G2012 for brief communications.
Making the Right Choice: Global vs Component Codes
Use Global Codes When
- Your practice manages the entire pregnancy.
Use Component Codes When
- The patient transitions between practices.
- You only perform delivery without providing prenatal care.
- Another practice manages postpartum care.
Real Examples
- A patient moves to a different location during pregnancy: The initial practice charges for the antepartum code, whereas the new practice charges for the global code.
- Hospital delivery involving a different obstetric group: The prenatal practice charges for the antepartum code, while the hospital group charges for the delivery-only code.
- You handle the call and provide an unknown patient: Charge the delivery-only code.
Essential Modifiers for 2025
Essential Modifiers You Should Use
- Modifier 25: Significant, separately identifiable E/M service on the same day as another procedure (note that this modifier is often misapplied in OB claims, so ensure proper documentation).
- Modifier 95: Telehealth services when utilizing traditional E/M codes (not required for new telehealth-specific CPT codes).
Modifiers That Don’t Belong on OB Claims
- Modifier 90: Laboratory services for reference (not applicable during global periods).
- Modifier 91: Laboratory tests repeated (not applicable during global periods).
These laboratory modifiers are irrelevant to obstetric global billing and can cause confusion in claims.
Understanding Various Payer Requirements
Medicare’s Strategy for OB Global Billing
Medicare employs the “MMM” indicator for obstetric global packages, setting them apart from surgical global periods. Telehealth coverage remains available until September 30, 2025, allowing patients to access services from home without geographic limitations.
Commercial Insurance Differences
Many insurers align with Medicare’s guidelines but may exhibit particular variations:
- The precise number of postpartum visits included.
- Distinct telehealth stipulations.
- State-specific regulations (such as North Carolina’s new F-codes effective after July 1, 2025).
It is essential to confirm the policies of individual payers instead of presuming consistent coverage.
How to Accurately Bill for OB/GYN in 2025?
Standard Pregnancy Care
The patient receives comprehensive prenatal care, undergoes delivery, and completes postpartum care within your practice.
Code: Employ the correct global code (59400, 59510, etc.)
Mid-Pregnancy Transfer
If a patient transfers to your practice at 28 weeks, you will provide continuous care and delivery.
Code: Apply the global code as you have delivered significant antepartum care along with the delivery.
Telehealth for Postpartum Complications
Should a patient experience postpartum depression necessitating a virtual consultation beyond standard care?
Code: Utilize the appropriate E/M code along with modifier 95 or code 98016, making certain that the correct place of service is specified.
High-Risk Pregnancy
A patient may require additional monitoring visits beyond standard care due to gestational diabetes.
Code: Bill the global code in addition to separate E/M codes for any medically necessary extra visits.
Common Billing Mistakes to Avoid
- Incorrect code selection: Utilizing global codes when only offering partial care.
- Misunderstanding telehealth: Billing separately for routine virtual visits that are part of the global package.
- Incorrect use of modifiers: Applying lab modifiers on obstetric claims or misapplying modifier 25 without adequate documentation.
- Inadequate complication documentation: Neglecting to substantiate separately billable services.
- Errors in transfer timing: Multiple providers billing global codes for the same pregnancy.
Preparing for Changes in Late 2025
Keep an eye on the expiration of expanded Medicare telehealth regulations on September 30, 2025, and the proposed billing updates for 2026 from ACOG and CMS. New telehealth codes may continue to evolve based on usage trends.
Ensure to:
- Invest in staff training and coding certification
- Allocate budget for updates to billing software
- Develop strong documentation practices
- Implement monitoring systems for billing performance
Key Takeaways
The changes to OB-GYN billing in 2025 are minimal yet significant. New telehealth-specific CPT codes have been introduced with limited recognition by Medicare, but the fundamental billing principles remain unchanged. Success hinges on accurate code selection based on the services rendered, thorough documentation, and keeping up-to-date with payer-specific policies.
Bear in mind that bundled services remain bundled regardless of the delivery method, component codes are available for partial care scenarios, and proper documentation is your strongest defense against denials and audits.