Understanding Global Maternity Billing Guidelines for OB/GYN Practices

"Global maternity" is a phrase every OB/GYN biller uses, but it's surprisingly easy to misapply. The global package bundles months of care into a single code — and the line between what's in the package and what's billed separately is where much of an obstetric practice's revenue is won or lost.

This guide explains where the guidelines come from, exactly what the package includes, what it doesn't, how payers layer their own rules on top, and what changes when the package is retired on January 1, 2027.

Where the guidelines come from

Three layers of rules govern global maternity billing:

1. CPT. The Maternity Care and Delivery section of the CPT codebook defines the package codes and describes what antepartum care, delivery services and postpartum care include. This is the foundation.
2. CMS. Medicare's Physician Fee Schedule lists maternity codes with a global surgery indicator of MMM — meaning the usual 0-, 10- and 90-day surgical global rules don't apply and the CPT maternity package concept governs. Medicare covers relatively few pregnancies, but many payers borrow CMS conventions.
3. Payers. Medicaid programs, managed care plans and commercial insurers publish obstetric billing policies that specify billing timing, date-of-service conventions, notification requirements, modifiers and how split care is handled. See global maternity billing by payer.

When someone refers to "CMS global maternity guidelines," they usually mean this combination: CPT's definitions as applied under Medicare's MMM convention.

What the global package covers

The four global codes:

Per CPT, the package includes:

Antepartum care — the initial and subsequent history, physical examinations, recording of weight, blood pressure and fetal heart tones, routine chemical urinalysis, and routine visits (generally monthly to 28 weeks, biweekly to 36 weeks, then weekly until delivery).

Delivery services — admission to the hospital, the admission history and physical, management of uncomplicated labor, and the delivery (vaginal with or without episiotomy and/or forceps, or cesarean), including delivery of the placenta.

Postpartum care — hospital visits after delivery and routine office visits following the delivery.

What's billed separately

The package covers routine care. Services outside routine care are reported in addition:

• Obstetric ultrasound (76801–76828) — see our OB ultrasound billing guide
• Fetal non-stress test (59025) and contraction stress test (59020)
• Amniocentesis (59000), cordocentesis and other fetal invasive procedures
• External cephalic version (59412)
• Cervical cerclage (59320, 59325)
• Laboratory testing performed in the office
• E/M visits for complications or unrelated conditions — for example, managing preeclampsia, gestational diabetes, hyperemesis or a urinary tract infection beyond routine visits — with diagnosis codes that show the problem
• Hospital care before labor for a complication (for example, antepartum admission for preterm labor that doesn't result in delivery)

Whether a complication visit is separately payable depends on the payer. Some pay any documented problem-oriented visit; others pay only when the complication requires significantly more care than routine visits. Know each payer's rule — and document the problem clearly.

When the global package doesn't apply

The package only fits when the same physician or group provides all routine antepartum care, the delivery and postpartum care. Otherwise, bill components:

Common reasons: transfers in or out, insurance changes, a delivering physician outside the group, or a pregnancy that ends before delivery. Our guide to itemized vs. global maternity billing and the split care worked example walk through these.

Group practices and the package

When several physicians in the same group share prenatal care and one delivers, the group generally bills the global package once — typically under the delivering physician's NPI, though payer instructions vary. Midwives and nurse practitioners in the group add a wrinkle: some payers require the package to be billed under the provider who delivered, and some have specific rules for midwife deliveries. Confirm with each major payer.

Diagnosis coding on global claims

The delivery claim carries the diagnoses for the delivery encounter:

• Principal diagnosis: the main circumstance or complication of the delivery — or O80 for a full-term, uncomplicated vaginal delivery of a single liveborn infant (used alone, with only Z37.0)
• Z3A.__: weeks of gestation at delivery
• Z37.__: outcome of delivery — required on every maternal delivery claim
• Other O codes for conditions that affected the pregnancy or delivery

For sequencing rules, see our ICD-10 O codes guide and multiple O codes article.

Billing timing and date of service

• Most payers expect the global code billed after delivery, often with the delivery date as the date of service.
• Some payers want a date span from the first antepartum visit to delivery.
• Some practices wait for the postpartum visit before billing — know each payer's timely-filing limit so the claim isn't late.
• Some Medicaid programs require notification early in pregnancy or bill antepartum visits as they occur.

Where practices lose money

• Not billing antepartum care when a patient transfers out or the pregnancy ends
• Billing the global code after a transfer in or insurance change
• Wrong delivery family — VBAC billed as routine, trial of labor ending in cesarean billed as planned cesarean
• Missing separately billable services — ultrasounds, NSTs, complication visits
• Diagnosis errors — missing Z37, misused O80
• Claims held too long after delivery

Read 7 global maternity billing mistakes for fixes.

What changes on January 1, 2027

The AMA's CPT 2027 code set deletes the global maternity package. For dates of service on or after January 1, 2027:

• Antepartum visits → E/M codes per encounter (office, hospital or telehealth)
• Labor → new per-day codes 59080–59083
• Delivery → 59431 (vaginal), 59432 (VBAC), 59502 (primary cesarean), 59503 (repeat cesarean), 59504 (cesarean hysterectomy)
• Postpartum → same-day care included in the delivery code; later visits by E/M

Read the 2027 maternity transition guide and our explainers on labor management codes and 2027 delivery codes.

Get help with global maternity billing

Our global maternity billing service tracks every pregnancy from the first visit to the final claim — and is preparing practices for 2027 now. Send us a WhatsApp message for a free review of your OB claims.