Global OB Package: The Questions Billers Actually Ask

2027 change: the mechanics on this page are built on the global package, which CPT deletes on January 1, 2027. Everything here applies through 2026 dates of service; see The 2027 Maternity Care Unbundling for what replaces it.

Billing mechanics

When do I submit the global claim, at delivery or as visits happen? At delivery, or after the postpartum visit, depending on the payer. Most commercial payers want the delivery date as the date of service and the claim held until the package is complete or the delivery has occurred. Billing routine visits as you go and then billing a global code on top is double billing; pick one model per payer per their policy.

What date of service goes on a global claim? The delivery date, for nearly all payers. A few want the date of the last service or a date range covering the episode. The payer’s OB billing policy states it; guessing wrong is a clean-claim rejection, not a denial you can appeal.

How many antepartum visits does the global package assume? Roughly 13 for a term pregnancy on the traditional schedule, but the package is not visit-counted on the way in. A patient seen 9 times or 16 times still generates one global code. Visit counts only start to matter when the package breaks apart, as in a transfer of care.

Do NP or PA prenatal visits count inside the global package? Yes, when they are part of the same practice’s care of the pregnancy. The package covers the episode of care, not one individual’s calendar. Bill the global under the delivering physician per the payer’s billing rules, and keep the visit records attributable. Where incident-to or supervision rules apply, they attach to the visits, not to whether the package exists.

A different physician in my group performed the delivery. Who bills the global? The practice bills one global package; same-group, same-specialty physicians are treated as one provider for the episode. Bill under the group with the delivering physician as rendering, unless the payer’s policy says otherwise. The package does not split because call schedules exist.

When the pregnancy does not follow the plan

The patient miscarried before delivery. What do I bill? There is no global package without a delivery. Bill the antepartum visits actually provided: 59425 or 59426 if the visit count supports them, individual E/M visits if not. Miscarriage management (medical or surgical) is billed separately with its own procedure codes.

The patient transferred out at 28 weeks. What do I bill? Antepartum-only codes based on your visit count: 59425 for 4 to 6 visits, 59426 for 7 or more, per-visit E/M below that. Do not bill a global code; the delivering practice may be billing components too, and overlapping globals deny for both practices. The transfer-of-care guide covers both sides.

The patient transferred in at 34 weeks and I delivered. Can I bill the global? Usually not the full global, because you did not provide the antepartum care it bundles. Most payers want delivery-plus-postpartum (59410 or 59515) plus an antepartum code for the visits you did provide. Billing 59400 on six weeks of involvement invites an audit.

The pregnancy is twins. Two globals? No, one global package for the pregnancy, with twin B’s delivery billed as a delivery-only code with modifier 59 (or modifier 22 on the global, depending on the payer). The per-fetus mechanics live in the twins coding guide.

The patient delivered preterm at 30 weeks after only 5 visits. Still a global? Yes, if you provided her care and the delivery. The global package does not have a minimum visit count; a short antepartum course compresses into the same code. Bill the global, not the components.

Insurance and coverage changes

The patient changed insurance mid-pregnancy. Who gets the global claim? The payer active on the delivery date gets the global claim in the majority pattern, but many payers instead require a split: antepartum codes to the first payer for the covered visits, delivery and remaining care to the second. Check both payers’ policies in writing before submitting, because the two models are mutually exclusive and the wrong one produces takebacks.

The patient had no coverage for the first trimester, then Medicaid kicked in. Now what? Bill Medicaid per its rules from the effective date, and check for retroactive eligibility covering the earlier visits; Medicaid retroactive coverage can reach back up to three months in many states. Where retro coverage applies, previously self-pay visits get rebilled to Medicaid and any patient payments refunded. See Medicaid OB billing.

Does Medicaid even pay global packages? Frequently not. Many state programs and their managed-care plans unbundle maternity care into per-visit payment plus a delivery code. Do not assume the commercial global model transfers; the state’s OB billing manual controls.

The postpartum tail

The patient never came back for the postpartum visit. Can I still bill the global? Most payers say yes, the global is billable after delivery even if the postpartum visit does not occur, since the package priced the expected course of care. A minority want delivery-only codes when postpartum care was not rendered. Document the outreach attempts either way; that documentation is what defends the global on audit.

The postpartum visit happened at a different practice. Does that change my code? Yes. Bill delivery-only (59409 or 59514) or delivery-plus-partial care per the payer’s rules, and let the practice that provided the postpartum visit bill 59430. Two practices cannot both be paid for the same postpartum care.

How long is the postpartum period inside the package? The traditional package runs through the routine postpartum visit, conventionally six weeks, but payer global windows vary; some define the maternity episode as ending 42 days after delivery, others extend it. Visits for new problems in that window are separately billable with the problem diagnosis; routine recovery checks are not. The global package guide draws the inside/outside line in detail.