Transfer of Care and Split OB Billing
When a pregnancy changes hands mid-course, the global package breaks into components, and both practices need to bill the right pieces. Here is how the split works, and what it costs.
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.
The component codes
The global package assumes one practice does everything. When it doesn’t, CPT provides the pieces:
| Code | Covers | When |
|---|---|---|
59425 | Antepartum care, 4–6 visits | You provided part of prenatal care, not delivery |
59426 | Antepartum care, 7+ visits | Same, with more visits |
| E/M per visit | Antepartum care, 1–3 visits | Too few visits for the antepartum codes |
59409 | Vaginal delivery only | You delivered but did not provide prenatal care |
59410 | Delivery + postpartum | You delivered and saw the patient postpartum |
59514 / 59515 | Cesarean equivalents | Same logic, cesarean route |
The receiving practice
A patient who transfers in at 32 weeks gets counted from her first visit with you. If you provide 6 visits and the delivery, most payers want the delivery-plus-postpartum code alongside 59425, not the full global package. Billing 59400 after a late transfer is one of the most reliable ways to earn a CO-50 or a post-payment audit.
The transferring practice
The practice that hands the patient off bills antepartum-only codes based on its visit count, with the last-visit date as the date of service for most payers. Document the transfer date explicitly; overlapping global claims from two practices trigger CO-119 denials for both.
The economics both sides should price in
Referring a high-risk patient out entirely forfeits the global fee: the practice trades roughly the full package payment for an antepartum-only code worth a fraction of it. This is why many OB practices prefer co-management for high-risk pregnancies: the practice keeps the patient and the global package while a maternal-fetal medicine specialist consults on the high-risk elements and bills those services separately. The consulting MFM’s services (detailed ultrasounds like 76811, consults, surveillance interpretation) are outside the global package either way, so co-management adds them without subtracting the global fee. Practices without an MFM nearby increasingly co-manage through telemedicine, which keeps the referral economics intact.
Documentation checklist for a clean split
- Transfer date recorded by both practices
- Visit count and flow sheet from the transferring practice
- Delivering practice bills delivery-only or delivery-plus-postpartum, not global, when prenatal care happened elsewhere
- Postpartum visit assigned to whichever practice actually provides it, billed per postpartum visit coding when it stands alone
FAQ
How many visits do I need for 59425 vs 59426? 59425 covers 4 to 6 antepartum visits; 59426 covers 7 or more. Fewer than 4, bill each visit as an E/M service.
Can two practices both bill a global code for one pregnancy? No. One pregnancy supports one global package at most. Splits are billed in components, and payers cross-check.
Does a single MFM consult break the global package? No. Consults and diagnostic services by another provider bill separately without affecting the primary practice’s global fee. The package breaks only when routine care itself changes hands.
Educational reference only. Not billing, legal, or medical advice. Confirm all codes, modifiers, and rates against current payer policy before submitting claims.