In 2025, hospitals that provide obstetrics and gynecology (OB/GYN) care face increasing billing and coding complexity. From maternity care and OB triage to telehealth billing and advanced surgical procedures, the accuracy and efficiency of your revenue cycle operations are critical.
Hospital-based medical billers and coders must apply the most current CPT®, ICD-10-PCS, DRG, and payer-specific guidelines. Mistakes in these areas cause delays in reimbursement, compliance risks, and unnecessary write-offs.
As a top OB/GYN billing services provider, MBC offers hospitals expert-driven, compliant, and high-performing medical billing services that ensure clean claims, fewer denials, and stronger cash flow.
5 OB-GYN Billing Challenges in 2025
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Managing OB Billing in Hospital Environments
The Challenge:
Hospitals coordinate OB care across inpatient units, outpatient clinics, and affiliated providers. Billing for maternity services (e.g., CPT® 59400–59622) becomes complex when multiple entities are involved in the same episode of care.
Hospital-Focused Solution:
- Centralize tracking of maternity services within your EHR or billing system.
- Apply accurate modifiers such as -24, -25, and -59 for separately billable services.
- Separate technical and professional components based on current ACOG and payer guidelines.
Medical Billers and Coders helps hospitals create clear billing workflows that ensure no services are missed or incorrectly bundled.
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Coding Challenges for OB/GYN Surgeries and Inpatient Procedures
The Challenge:
OB/GYN surgeries—such as cesarean deliveries, hysterectomies, and laparoscopies—require correct use of ICD-10-PCS codes, accurate DRG assignments, and complete documentation. Errors result in underpayment or audits.
Hospital-Focused Solution:
- Train coders to apply surgical codes based on approach, laterality, and procedure intent.
- Use NCCI edits to prevent unbundling of services performed during the same session.
- Track DRG shifts and ensure documentation supports severity levels for inpatient billing.
Through our medical billing services, MBC ensures inpatient OB/GYN procedures are coded and billed with precision.
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Billing Inconsistencies from Payer-Specific Policies
The Challenge:
Payer rules for OB/GYN services such as fetal testing, infertility evaluations, and high-level ultrasounds vary by contract. Denials often occur due to missing pre-authorizations, incorrect CPT usage, or unsupported diagnoses.
Hospital-Focused Solution:
- Create payer-specific billing guides built into your revenue cycle system.
- Implement pre-check workflows to verify authorizations and coverage before services are rendered.
- Monitor denial patterns and adjust front-end processes accordingly.
MBC provides hospitals with the tools and support to align billing with payer requirements from the start.
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Proper Billing of Preventive and Diagnostic OB/GYN Care
The Challenge:
Outpatient departments and hospital-based clinics often deliver preventive and diagnostic services on the same day. Billing both correctly is difficult without specific documentation and modifier usage.
Hospital-Focused Solution:
- Use modifier -25 to differentiate E/M services performed alongside preventive care.
- Document the medical necessity and details of each service clearly and separately.
- Refer to CMS and commercial payer rules for proper coding of well-woman exams and screenings.
Medical Billers and Coders assist hospitals in capturing full reimbursement while remaining compliant with all preventive billing rules.
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Billing Compliance for OB/GYN Telehealth and RPM Services
The Challenge:
Telehealth and remote monitoring are now widely used in OB/GYN care—for prenatal check-ins, postpartum follow-ups, and behavioral health screenings. Billing these services incorrectly can lead to denials or lost revenue.
Hospital-Focused Solution:
- Use POS 02 or 10 based on the care setting, and apply modifier -95 for eligible telehealth services.
- Document the platform used, patient consent, and time spent for each session.
- Stay current with CMS and commercial payer requirements for virtual OB/GYN care.
As part of our OB/GYN-focused medical billing services, Medical Billers and Coders offers hospitals pre-configured templates and compliant workflows for virtual care billing.
Why Hospitals Choose Medical Billers and Coders
Hospitals choose Medical Billers and Coders because we offer:
- Specialty OB/GYN Expertise – Coding knowledge across maternity, surgery, diagnostics, and preventive care.
- Hospital Workflow Integration – Support for Epic, Cerner, Meditech, Athena, and other leading platforms.
- Certified Coders and RCM Specialists – AAPC- and AHIMA-certified professionals with inpatient OB/GYN billing experience.
- Advanced Denial Management – Real-time insights, custom reporting, and payer-specific appeals handling.
From women’s health expansion projects to revenue cycle optimization, our team delivers results hospitals can trust.
Final Thoughts
In 2025, OB/GYN billing requires exact documentation, accurate coding, and a team that understands the full revenue cycle. Hospitals cannot afford billing gaps, denials, or compliance issues—especially in a high-volume, high-liability area like obstetrics and gynecology.
Medical Billers and Coders delivers industry-leading OB/GYN billing services that help hospitals maintain revenue, reduce errors, and stay fully compliant.
Contact the Top OB/GYN Billing Services Provider Today
Looking to strengthen your OB/GYN billing performance, reduce denials, and increase collections?
Contact Medical Billers and Coders today to schedule a consultation and learn how our medical billing services can support your hospital’s financial success.
References:
- American College of Obstetricians and Gynecologists (ACOG). “Coding and Reimbursement Guidance.” 2025. https://www.acog.org
- Centers for Medicare & Medicaid Services (CMS). “Inpatient and Telehealth Billing Rules.” 2025. https://www.cms.gov
FAQs
Typical denial reasons include coding errors, missing modifiers, lack of prior authorization, and insufficient documentation—issues effectively managed with support from medical billing services providers.
Telehealth visits require modifier -95, accurate POS codes, and thorough documentation of time and consent, all of which are handled efficiently by expert billing teams.
Codes 99381–99397 are used based on the patient’s age and visit type; providers should consult billing specialists to ensure payer compliance.
Yes, many procedures such as fetal diagnostics or minimally invasive surgeries require pre-authorization, which experienced billing services can manage proactively.
Outsourcing to a top OB/GYN billing services provider offers hospitals better claim accuracy, fewer denials, and enhanced reimbursement efficiency.
Billing codes should be reviewed quarterly to remain current with updates from ACOG, CMS, and commercial payers—best managed with the help of billing professionals.
