Key Takeaways
- Know your top OB GYN CPT codes—especially for maternity care, diagnostics, and procedures.
- Avoid denials by using accurate modifiers, up-to-date codes, and proper documentation.
- Pair CPT codes with the right ICD-10 diagnoses to support reimbursement and reduce errors.
- Learn how to prevent allowable mismatch with our comprehensive guide.
For OB/GYN practice managers, missed codes, outdated modifiers, or mismatched diagnoses don’t just mean billing errors. They mean lost revenue.
Billing errors in OBGYN can cost you thousands in missed reimbursements—meaning less revenue and fewer resources to pad your practice. Coding errors are one of the top reasons claims are denied, delayed, or underpaid. With evolving coding rules, bundled maternity care, and a mix of outpatient and surgical services, even small oversights can lead to denied claims or compliance issues.
Table of Contents
Global Obstetric Care Codes
Obstetric care often spans several months and involves multiple visits, diagnostics, and procedures. These CPT codes are used to simplify reimbursement by bundling all routine prenatal, delivery, and postpartum services into a single code. Use them only when a single provider manages the full pregnancy cycle.
These codes bundle prenatal visits, delivery, and postpartum care into one line item.
- 59400 – Routine obstetric care including vaginal delivery Routine obstetric care including vaginal delivery. Covers prenatal visits, labor management, vaginal birth, and postpartum follow-up when provided by the same physician or group.
- 59510 – Routine OB care including cesarean delivery. Includes all antepartum care, a scheduled or emergency C-section, and postpartum follow-up.
- 59610 – Vaginal delivery after previous cesarean (VBAC). Used when the patient delivers vaginally after a history of C-section, with complete prenatal and postpartum care.
- 59618 – Attempted VBAC, ended in a repeat cesarean. Indicates labor was attempted vaginally but converted to cesarean with full perinatal care.
Tip: Use global codes only if the same provider delivers all components of care.
Standalone OB Services
When care is split between providers or the patient receives only a portion of pregnancy-related services, standalone codes are essential. These CPT codes let you bill accurately for individual components like delivery-only or postpartum-only care.
Use these when patients transfer care or do not receive all services in a global bundle.
- 59409 – Vaginal delivery only. Billable when the physician provides just the delivery portion of care, without prenatal or postpartum components.
- 59514 – Cesarean delivery only. Used when a provider performs the C-section but did not handle prenatal or postpartum services.
- 59430 – Postpartum care only. Covers routine follow-up visits after delivery, including physical and emotional recovery assessments.
- 59025 – Fetal non-stress test. Non-invasive test used to monitor fetal heart rate in response to movement, often used in high-risk pregnancies.
- 59050 – Continuous electronic fetal monitoring. Continuous tracing of fetal heart tones and contractions during labor, billed separately when not included in global delivery.
OB Ultrasound CPT Codes
Ultrasound is one of the most frequently performed diagnostic tools in OB care. These CPT codes differentiate by trimester, fetal count, and complexity of the scan. Selecting the correct code helps ensure your documentation aligns with payer requirements.
These cover first, second, and third trimester imaging.
- 76801 – First-trimester ultrasound, single fetus. A detailed transabdominal scan used to evaluate fetal viability, gestational age, and early development.
- 76802 – First-trimester ultrasound, additional fetus. Applied in multifetal pregnancies to account for imaging each additional fetus beyond the first.
- 76805 – Standard second/third trimester, single fetus. A comprehensive scan evaluating fetal growth, anatomy, placenta location, and amniotic fluid volume.
- 76810 – Second/third trimester, additional fetus. Use this code when assessing additional fetuses during a comprehensive later-pregnancy scan.
- 76815 – Limited OB ultrasound (e.g., fetal heartbeat or position). Used for specific, quick assessments rather than full evaluations—commonly in triage or labor.
- 76817 – Transvaginal ultrasound during pregnancy. Allows high-resolution evaluation of early fetal development or cervix length for preterm labor risk.
Tip: Be sure to document medical necessity and gestational age.
Common Gynecologic Diagnostic Codes
These codes are used when investigating symptoms like pelvic pain, abnormal uterine bleeding, or infertility. Proper coding not only helps you get reimbursed but also supports continuity of care between providers and payers.
Used to evaluate pelvic pain, abnormal bleeding, or fertility challenges.
- 57452 – Colposcopy of cervix. A magnified visual exam using a colposcope to identify abnormal cervical lesions, often following an abnormal Pap test.
- 58100 – Endometrial biopsy (without dilation). Involves sampling the uterine lining to evaluate abnormal bleeding, infertility, or suspected endometrial disease.
- 76830 – Transvaginal ultrasound (non-obstetric). High-resolution scan to assess uterus, ovaries, or pelvic masses outside of pregnancy.
- 58340 – Catheterization for hysterosalpingography. Involves inserting a catheter into the uterus to deliver contrast for imaging tubal patency and uterine cavity shape.
- 58110 – Endometrial biopsy performed with IUD in place.
Gynecology Surgical CPT Codes
From minimally invasive laparoscopies to full hysterectomies, these procedures carry significant reimbursement value. That also means they’re highly scrutinized. Thorough documentation and correct code selection are essential.
These high-value procedures require accurate documentation to avoid underbilling.
- 58140 – Myomectomy, 1–4 fibroids. Surgical removal of up to four uterine fibroids via abdominal incision, typically used to treat heavy bleeding or infertility.
- 58150 – Total abdominal hysterectomy. Complete removal of the uterus and cervix through an open abdominal approach, often performed for fibroids or cancer.
- 58570 – Laparoscopic hysterectomy (uterus ≤ 250g). Minimally invasive removal of a normal-sized uterus and cervix with laparoscopic assistance.
- 58661 – Laparoscopic removal of adnexa (ovary and/or fallopian tube). Performed to manage ectopic pregnancy, ovarian cysts, or suspected malignancy.
- 58940 – Removal of ovary (oophorectomy). Open surgical excision of one or both ovaries, often part of a cancer staging or hormonal management plan.
Tip: Include laterality and size of pathology when applicable.
Infertility & Assisted Reproductive Services
Reproductive endocrinology has its own unique set of procedural codes. Whether billing for IVF-related services or egg retrievals, these codes help convey both the procedure performed and its context in fertility treatment plans.
Used frequently in fertility clinics and reproductive endocrinology.
- 58970 – Oocyte (egg) retrieval. A transvaginal procedure using ultrasound guidance to extract mature follicles during in vitro fertilization cycles.
- 58974 – Embryo transfer. Placement of fertilized embryos into the uterus during assisted reproduction, typically 3–5 days post-retrieval.
- 58976 – Gamete or zygote intrafallopian transfer (GIFT/ZIFT). Placement of unfertilized gametes or zygotes directly into the fallopian tubes via laparoscopic access.
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Contraceptive Management Codes
Contraceptive care involves device placement, removal, and counseling. These CPT codes support billing for both short-term and long-acting methods and are critical for documenting preventive care services.
- 58300 – IUD insertion. Placement of an intrauterine device for long-term reversible contraception, performed in-office using sterile technique.
- 58301 – IUD removal. Extraction of an intrauterine device, typically performed in-office and requiring gentle traction on retrieval strings.
- 11981 – Implantable contraceptive insertion. In-office procedure where a subdermal implant (e.g., Nexplanon) is placed for long-term hormonal contraception, typically effective for up to three years.
- 11982 – Removal of contraceptive implant. Procedure to extract the subdermal device using local anesthesia, usually in an outpatient or clinic setting.
- 11983 – Removal with reinsertion of contraceptive implant. Combines extraction of an expired or problematic device with immediate placement of a new one in the same session.
CPT Coding Scenarios to Watch
Real-world situations don’t always follow billing textbooks. This section highlights practical examples—like miscarriage management and high-risk pregnancies—where CPT selection can vary based on timing, complexity, and method.
Missed Abortion
- 59812 – Incomplete miscarriage (D&C). Performed when retained products of conception are present following spontaneous abortion, typically involving suction or sharp curettage.
- 59820 – Treatment of missed abortion, first trimester. Surgical management of non-viable pregnancy when fetal demise occurs without expulsion, requiring uterine evacuation.
Elective Abortion
- 59840 – Induced abortion, D&C with suction. Elective termination of pregnancy through cervical dilation and vacuum aspiration in the first trimester.
High-Risk Pregnancy Monitoring
- 76816 – Follow-up OB ultrasound. Targeted scan used to re-evaluate fetal or maternal concerns found during a prior ultrasound, such as growth or fluid abnormalities.
- 99205 – High-complexity E/M new patient visit. Extended comprehensive visit involving high medical decision complexity and typically over 60 minutes of provider time.
Chronic Pelvic Pain
- 99214 – Established patient visit, moderate complexity. Used for follow-ups that require medical decision making of moderate complexity, such as ongoing pelvic pain or abnormal bleeding.
- 64561 – Implantation of neurostimulator for pelvic pain (when applicable). Typically part of an interventional pain management plan for chronic pelvic or sacral nerve-related discomfort.
3 Key Elements of Accurate OBGYN Coding
Now that you have a firm grasp of the most important obstetrics and gynecology billing codes, you might ask yourself: how do I use this information to avoid revenue-draining errors? Let’s dive in.
Know Your Global Packages
Global maternity codes include all routine visits, labor and delivery, and postpartum follow-up. Billing separately for bundled services leads to denials.
Use Modifiers Wisely
- Modifier 25 – Significant, separately identifiable E/M service
- Modifier 59 – Distinct procedural service
- Modifier 51 – Multiple procedures
- Modifier 76 – Repeat procedure by same provider
- Modifier GT/95 – Telehealth visits
Pair CPT With Proper ICD-10 Codes
Incorrect diagnosis codes lead to denials, even if the CPT is correct. Always support your CPT codes for OBGYN procedures with accurate ICD-10 documentation.
Documentation Tips to Support CPT Billing Codes for OBGYN
Even with the right CPT codes, you won’t get reimbursed without proper documentation. Payers rely on detailed records to verify that billed services were medically necessary and performed correctly. Incomplete or vague documentation can lead to denials or delayed payments.These tips help ensure your documentation backs up every code submitted:
- Link every CPT code to a medically necessary ICD-10 diagnosis: The diagnosis should clearly justify why the service was needed. Be specific rather than general—”menorrhagia due to uterine fibroids” provides more support than “abnormal bleeding.”
- For procedures, document:
- Who performed it, including credentials and role (e.g., attending physician, resident, midwife).
- Method and findings, such as “laparoscopic approach” and intraoperative observations.
- Time, anesthesia (if any), and follow-up instructions like post-op care or discharge orders.
- Use standardized templates and checklists to reduce oversight: Built-in EHR prompts can help ensure nothing is missed during documentation and reduce variation across providers.
Stay Updated, Stay Paid
From managing complex maternity packages to billing high-dollar surgical cases, accurate coding is one of the most important (and undervalued) parts of your OB/GYN practice. Bookmark this page to reduce denials, speed up reimbursement, and get paid for the care you provide.
FAQs: CPT Codes for OBGYN Practices
Can I bill 59425 and 59400 together?
No. 59425 is for antepartum-only care, and 59400 is for global maternity. Use one or the other based on scope of care.
How do I code for a miscarriage?
Use codes like 59812 for incomplete spontaneous abortion and 59820 for treatment of a missed abortion.
What’s the difference between 59510 and 59514?
59510 is for full prenatal + cesarean delivery + postpartum. 59514 is for cesarean delivery only.
At ObGyn-Cloud, we help practices avoid these common mistakes and improve performance with expert billing support tailored specifically to OB/GYN. Our EHR and billing services work together to catch errors before claims go out, so you get paid accurately the first time.
