OBGYN Billing in California: How to Bill Global Maternity Packages Correctly

OBGYN billing in California presents unique challenges that can make or break your practice’s financial health, particularly when it comes to global maternity packages. These bundled services—covering antepartum care, delivery, and postpartum visits—represent $3,000-$8,000+ per patient in reimbursement; yet, California OBGYN practices routinely lose 15-25% of potential maternity revenue due to incorrect coding, incomplete documentation, and a misunderstanding of global package requirements. With the average OBGYN practice managing 15-30 deliveries monthly, these errors translate to $80,000-$180,000 in annual revenue loss.

Understanding OBGYN billing in California requires mastering the distinction between global maternity codes (59400, 59510, 59610, 59618) and their parts, knowing when to bill globally versus unbundle services, and navigating California’s complex payer landscape, including Medi-Cal, Blue Shield of California, Anthem Blue Cross, Health Net, and Kaiser. Medical Billers and Coders (MBC) specializes in helping California OBGYN practices optimize maternity billing through expert coding, comprehensive documentation support, and systematic quality assurance, ensuring every delivery generates maximum, appropriate reimbursement.

Understanding Global Maternity Packages in California

Global maternity billing represents a bundled payment approach, where a single comprehensive code encompasses all routine services related to pregnancy, delivery, and postpartum care. The most common global codes for OBGYN billing in California include CPT 59400 (vaginal delivery with routine antepartum and postpartum care), CPT 59510 (cesarean delivery with routine antepartum and postpartum care), CPT 59610 (VBAC delivery with routine antepartum and postpartum care), and CPT 59618 (cesarean delivery following attempted VBAC with routine care).

These global codes bundle together antepartum care (typically 7-13 visits depending on when care begins), delivery and immediate postpartum hospital care, and postpartum office visit (typically one visit within 6 weeks of delivery). Understanding exactly what’s included versus excluded from global packages is critical—billing separately for services included in the worldwide package results in denials, while failing to bill separately for excluded services leaves money on the table.

California payers have specific definitions of what constitutes “routine” antepartum care versus complications requiring separate billing. Additionally, Medi-Cal has unique billing requirements that differ from commercial payers, making OBGYN billing in California particularly complex. The financial stakes are high—a vaginal delivery global package typically reimburses $3,500-$5,500, while cesarean sections reimburse $5,000-$8,000+. Coding errors that result in downcoding or unbundling reduce these payments by 20-40%.

Common Global Maternity Billing Mistakes in California OBGYN Practices

Incorrect Patient Initiation Date Calculation: Global maternity billing requires documenting when prenatal care began. If a patient presents at 12 weeks of gestation and delivers at 40 weeks, you’ve provided 28 weeks of care—the full antepartum component. However, if care began at 32 weeks, you’ve provided only 8 weeks, which doesn’t qualify for the whole global package. California OBGYN practices frequently bill full global codes, regardless of when care actually started, which can trigger audits and recoupment. Proper OBGYN billing in California requires tracking care initiation dates meticulously and unbundling services when global criteria aren’t met.

Failure to Unbundle When Required: When patients transfer care mid-pregnancy, experience complications requiring hospitalization separate from delivery, or deliver before completing the full antepartum component, practices must unbundle the global package. This means billing separately for antepartum visits (99201-99215 or 59425-59426), delivery only (59409, 59514, 59612, 59620), and postpartum care (59430). California practices often incorrectly bill global codes in these scenarios, resulting in overpayment flags, audits, and recoupment demands with penalties.

Missing High-Risk Pregnancy Documentation: Many California OBGYN practices treat high-risk pregnancies involving gestational diabetes, preeclampsia, placenta previa, preterm labor, or multiple gestations. These conditions often require additional monitoring, testing, and visits beyond routine care. When adequately documented with appropriate ICD-10 codes and demonstrating medical necessity, these extra services can be billed separately from the global package. However, practices frequently provide extensive high-risk management without documenting and billing it separately, resulting in significant revenue loss. Effective OBGYN billing in California requires distinguishing between routine global care and separately billable high-risk services.

Improper Billing of Ultrasounds and Testing: Routine ultrasounds (typically 1-2 during pregnancy) are generally included in global packages for California commercial payers, though Medi-Cal has different rules. Additional ultrasounds for medical indications, such as anatomy scans, growth assessments, and Doppler studies for high-risk conditions, are separately billable with proper documentation. California OBGYN practices make two common errors: billing routine ultrasounds separately (triggering denials and audit flags) or failing to bill medically necessary additional ultrasounds (leaving money uncaptured). Knowing payer-specific ultrasound policies is essential.

Postpartum Visit Documentation Failures: Global packages typically include one postpartum visit, which is typically scheduled 4-6 weeks after delivery. If patients require additional postpartum visits for complications like wound infections, postpartum depression screening, or contraception counseling, these visits are separately billable with appropriate diagnosis codes and modifier 24. California practices often fail to bill these separately, assuming they’re included in the global package, or bill them without proper modifiers, resulting in denials. Additionally, when patients fail to attend postpartum visits, practices must document attempts to contact the patient and consider whether complete global billing is warranted.

Cesarean Section Complications Undercoding: When cesarean deliveries involve complications—such as hemorrhage, retained placenta, hysterectomy, or bladder injury—additional procedure codes may be billable alongside the global delivery code with the appropriate modifiers. California OBGYN practices often provide these complex services but fail to code and bill them, resulting in substantial reimbursement losses. For example, a cesarean hysterectomy (59525) pays significantly more than a routine cesarean, but requires specific documentation and coding expertise.

Medi-Cal Unique Billing Requirements: California’s Medi-Cal program has distinct global maternity billing rules that differ from commercial payers. Medi-Cal allows separate billing for ultrasounds under specific circumstances, has distinct global package definitions, requires specific authorization processes, and employs different reimbursement methodologies. OBGYN billing in California requires expertise in both commercial and Medi-Cal rules—treating them identically results in significant revenue loss and compliance issues.

How MBC Optimizes OBGYN Billing in California for Maternity Services

Medical Billers and Coders brings over 25 years of specialized healthcare revenue cycle management expertise to California OBGYN practices, with a particular focus on global maternity package billing. Our comprehensive approach ensures practices capture maximum appropriate reimbursement while maintaining complete compliance with California payer requirements.

Care Initiation Date Tracking Systems

We implement systematic tracking of when prenatal care begins for each patient, ensuring global versus unbundled billing decisions are accurate. Our systems document initial prenatal visit dates, calculate the weeks of care provided at delivery, flag patients requiring unbundled billing due to late care initiation or early delivery, and generate appropriate billing recommendations—either global or component codes. This tracking integrates with your EHR system—whether you use Epic, Cerner, athenahealth, or OBGYN-specific platforms like OB TraceVue or Maternity Neighborhood—ensuring data flows naturally within clinical workflows.

Accurate care tracking prevents the most common OBGYN billing errors in California: billing global packages when unbundling is required, or unbundling when global billing is appropriate and more profitable. Our systems eliminate guesswork and ensure that billing accurately reflects the actual services provided.

Expert OBGYN Coding Specialists

Our certified OBGYN coders specialize in maternity billing and are well-versed in the nuances of California payer policies. We ensure maximum reimbursement through the correct selection of global package codes (59400, 59510, 59610, 59618), appropriate unbundling when circumstances require component billing, additional procedure coding for complications and complex deliveries, identification and coding of high-risk pregnancy services, and proper modifier usage for multiple procedures and unusual circumstances.

This expertise is particularly valuable for complex scenarios like VBAC attempts that result in cesarean delivery, twin deliveries requiring separate coding for each infant, deliveries complicated by concurrent procedures, and high-risk pregnancies requiring extensive additional monitoring. Our coders stay current with annual CPT changes and California payer policy updates affecting OBGYN billing.

Comprehensive Documentation Review and Enhancement

Global maternity billing lives or dies on the quality of documentation. California audits increasingly scrutinize OBGYN practices, and insufficient documentation results in recoupment that can exceed original payments by 3-5x with penalties. MBC provides proactive documentation review, including verification that prenatal records support global billing claims, confirmation of postpartum visit completion and documentation, validation of medical necessity for separately billed services, and review of delivery operative notes for completeness and coding accuracy.

We also provide documentation templates and training for antepartum visit documentation, delivery operative note requirements, postpartum visit documentation, and high-risk pregnancy tracking and justification. These templates integrate with your EHR, making complete documentation easier rather than burdensome.

California Payer-Specific Billing Strategies

OBGYN billing in California requires an understanding of the distinct requirements for major payers. MBC manages payer-specific strategies for Medi-Cal maternity billing, including unique authorization and coding rules, as well as commercial policies for Blue Shield of California and Anthem Blue Cross, and requirements for Health Net, Kaiser, and smaller regional plans such as LA Care, Molina, and Central California Alliance for Health.

Each payer has different policies regarding what’s included in global packages, how to bill ultrasounds and testing, when unbundling is required, and how to code high-risk pregnancy services. Our expertise ensures your practice bills correctly for each payer, maximizing reimbursement while maintaining compliance.

Real-Time Claim Scrubbing Technology

Before any OBGYN claim reaches a California payer, our system-agnostic platform performs comprehensive scrubbing. We verify that global billing criteria are met (care initiation date, complete antepartum care, delivery, postpartum visit), confirm appropriate unbundling when global criteria aren’t satisfied, validate additional procedures and services are properly coded with modifiers, check that diagnosis codes support services billed, establish medical necessity, and ensure claims comply with payer-specific policies.

This technology-driven approach catches errors before submission, reducing denial rates by 40-50% and eliminating costly rework. For California OBGYN practices managing high delivery volumes, prevention is exponentially more efficient than appealing denied claims after the fact.

Dedicated Account Management for California OBGYN Practices

Unlike billing companies providing generic services across specialties and states, MBC assigns dedicated account managers who understand California’s OBGYN landscape. Your account manager knows California payer mix, including Medi-Cal managed care plans, understands regional differences in payer policies across Northern and Southern California, tracks your maternity billing performance and denial patterns, and provides strategic guidance on optimizing reimbursement.

This personalized approach delivers faster resolution when billing issues arise, proactive identification of documentation or coding problems, regular reporting tailored to OBGYN maternity metrics, and strategic planning for value-based care contracts and alternative payment models. OBGYN billing in California requires local expertise—our dedicated managers provide that knowledge and support.

Optimizing Non-Maternity OBGYN Services in California

While global maternity packages represent substantial revenue, comprehensive OBGYN billing in California includes optimizing gynecology services that many practices undercode or fail to bill correctly.

Annual Well-Woman Visits: Preventive gynecology visits (G0101, 99384-99397) are frequently billed incorrectly. When these visits uncover problems requiring additional evaluation—such as abnormal Pap smears, pelvic masses, or abnormal bleeding—additional E/M services may be separately billable with modifier 25. California practices often fail to bill these services separately, resulting in lost revenue. Conversely, billing them without proper documentation triggers audits. MBC ensures that coding is appropriate, capturing all billable services while maintaining compliance.

Office Procedures: Gynecology practices perform numerous office procedures, including IUD insertions, endometrial biopsies, colposcopies, cryotherapy, and LEEP procedures, that generate significant revenue when coded correctly. These procedures require the proper selection of CPT codes, the use of appropriate modifiers, documentation of medical necessity, and coordination with any E/M services provided on the same day. Our expertise ensures maximum reimbursement for office-based procedures.

Surgical Services: Beyond deliveries, OBGYN practices perform hysterectomies, laparoscopies, hysteroscopies, and other surgical procedures with complex coding requirements. California payer policies regarding global surgical periods, modifier usage, and bundling rules significantly impact reimbursement. MBC’s surgical coding expertise ensures these high-value services generate appropriate payment.

Strategic Denial Management for OBGYN Claims

Despite best prevention efforts, some OBGYN claims face denials. MBC’s denial management process recovers denied revenue through systematic appeal strategies tailored to California payers and maternity billing issues.

We categorize denials by root cause, including global billing inappropriately applied, insufficient documentation of care components, coding errors or missing modifiers, or payer policy misunderstandings. Each category requires different appeal approaches. For global billing disputes, we compile comprehensive prenatal records demonstrating the care provided. For medical necessity denials, we submit detailed clinical documentation with evidence-based guidelines. For technical denials, we correct and resubmit with explanations.

Our appeal success rate for OBGYN maternity denials exceeds 60%, recovering substantial revenue that practices would otherwise write off. This success stems from understanding California’s payer review processes, maintaining relationships with payer medical review staff, and crafting appeals that address specific denial reasons with compelling documentation and regulatory support.

Recovering Lost Revenue Through Old A/R Management

Many California OBGYN practices carry significant accounts receivable from denied maternity claims, payment delays, and patient balances. These aged claims often represent $150,000 to $400,000 in potentially recoverable revenue.

MBC’s Old A/R Recovery Services systematically recovers these high-value claims through a comprehensive audit of aged maternity claims, identification of denial patterns and systemic billing issues, strategic appeal planning that prioritizes the highest-value recoverable claims, and persistent follow-up with California payers and patient payment plans.

We’ve helped California OBGYN practices recover 30-40% of previously considered uncollectible aged accounts receivable. For a practice with $300,000 in aged maternity claims, this translates to $90,000-$120,000 in recovered revenue, directly improving profitability without requiring additional patient volume.

The Financial Impact of Specialized OBGYN Billing

When California OBGYN practices partner with MBC for comprehensive revenue cycle management focused on maternity services, the financial transformation is measurable and substantial. Typical improvements within 90-120 days include 30-45% reduction in maternity claim denials, 15-25% increase in average reimbursement per delivery through correct coding, 25-30% decrease in days in accounts receivable, recovery of 30-40% of aged maternity A/R, and improved cash flow predictability with reduced payment delays.

For a California OBGYN practice managing 20 deliveries monthly with average reimbursement of $5,000, reducing denials from 20% to 8% and improving average reimbursement by 15% generates an additional $18,000+ monthly—over $216,000 annually. Combined with recovered aged accounts receivable (A/R) and optimized gynecology billing, a total practice revenue improvement of $300,000-$500,000 within the first year is achievable.

Beyond direct revenue, specialized OBGYN billing in California reduces administrative burden. Physicians spend less time on peer-to-peer reviews and appeals. Office staff focuses on patient care rather than claim rework. Practice managers gain clear visibility into revenue cycle performance with actionable metrics specific to maternity services.

System-Agnostic Integration for California OBGYN Practices

California OBGYN practices utilize diverse EHR and practice management systems, including Epic (standard in large medical groups), Cerner, athenahealth, eClinicalWorks, and specialty OBGYN platforms. MBC’s system-agnostic approach to OBGYN billing in California means you never need to change software to access expert maternity billing services.

We integrate seamlessly with your existing technology, extracting prenatal care documentation, delivery operative notes, and postpartum visit records necessary for accurate billing and reimbursement. Our platform posts payments, provides real-time reporting, and updates your system with claim status—all without disrupting clinical workflows or requiring expensive system migrations.

This flexibility is crucial for OBGYN practices, where physicians have customized prenatal templates, standardized delivery documentation, and integrated clinical pathways built into their existing systems. Forcing a software change to accommodate a billing company creates physician resistance and productivity losses that negate any billing improvements.

Schedule Your OBGYN RCM Audit Today

Don’t let global maternity billing errors and inefficient revenue cycle management drain your California OBGYN practice’s financial health. Medical Billers and Coders offers a comprehensive RCM audit specifically designed for OBGYN practices, identifying exactly where maternity revenue is being lost and providing a detailed recovery roadmap.

Our audit examines your current global maternity billing accuracy and appropriateness, care initiation date tracking and unbundling decisions, documentation completeness for international packages and high-risk services, denial patterns and root causes specific to maternity claims, accounts receivable aging with focus on high-value delivery claims, and payer-specific billing compliance for Medi-Cal and commercial carriers.

Schedule your audit today and discover how MBC’s 25+ years of specialized healthcare RCM expertise, dedicated account management for California practices, and proven OBGYN billing methodologies can transform your practice’s financial performance. Our team understands the unique challenges of OBGYN billing in California and has proven strategies to optimize maternity package billing, reduce denials, and maximize reimbursement.

Contact Medical Billers and Coders now to begin protecting your practice’s maternity revenue with specialized OBGYN billing services designed specifically for California providers. Your expertise brings new life into the world—let our expertise bring new revenue into your practice.

FAQs on OBGYN Billing in California