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OB/GYN Billing Services
We provide OBGYN medical billing services to independent practices: coding, claim submission, payment posting and AR follow-up. Our coders hold CPC and CCS certifications and work at 98.9% coding accuracy across our coding work. We bill all payers, including Medicaid, and work in the EHR you already use.
What Does OB/GYN Billing Actually Involve?
OB/GYN billing and coding combines global obstetric packages that pay prenatal, delivery and postpartum care as one code, separately billable high-risk and ultrasound services, gynecologic surgery, and preventive well-woman care billed under its own rules. When a patient transfers or changes insurance mid-pregnancy, the package has to be split into antepartum, delivery and postpartum codes. Qualigenix handles that work for OB/GYN practices, from maternity benefits verification to appeals. Call 786-259-0231 to talk through your current numbers.
01
Global Maternity Billing & Unbundling
Global codes 59400 (vaginal delivery), 59510 (cesarean) and 59610 (VBAC) include routine antepartum visits, the delivery and routine postpartum care. Services outside the package, such as visits for unrelated conditions or high-risk care beyond routine prenatal care, can be billed separately with documentation that shows why. Billing them inside the package loses revenue. Billing routine visits outside it gets denied.
02
Prior Auth for GYN Surgery & Ultrasounds
Hysterectomy, laparoscopic procedures, detailed fetal anatomy scans (76811), genetic testing and many fertility services need prior authorization from commercial and Medicaid plans. A case done without the authorization number is usually a full denial.
03
Antepartum Visit Counting in Split Care
When a patient transfers in or out, or delivers with another group, the global code can't be used. Antepartum care is then billed by visit count: 59425 for 4 to 6 visits, 59426 for 7 or more, and standard E/M codes for 1 to 3 visits. Delivery-only and postpartum-only codes (59409, 59410, 59430 and the cesarean equivalents) cover the rest. Practices that don't count visits at delivery often bill the wrong code or nothing at all.
04
Same-Day Preventive & Problem Visits
A well-woman exam and a separately identifiable problem visit on the same date can both be paid. The problem visit needs modifier 25 and documentation that shows it went beyond the preventive service. Without that, the payer bundles it.
05
Mid-Pregnancy Coverage & Medicaid Eligibility
Patients change plans during pregnancy, and many move onto Medicaid pregnancy coverage after the first visits. Each payer pays only for the care delivered while it covered the patient, so the global package has to be split by payer and date.
06
Ultrasound Medical Necessity Documentation
Obstetric ultrasounds are billed by trimester, by detail and by approach (76801, 76805, 76811, 76815, 76816, 76817), and payers limit how many they will pay per pregnancy without a documented indication. Each scan needs the reason for the study in the order and the report.
07
Ultrasound, Modifier 25, & Global-Period Denials
Common OB/GYN denials include ultrasounds over the payer's frequency limit, same-day problem visits without modifier 25, and visits or procedures billed inside a surgical or obstetric global period.
08
Preventive, Medicaid Maternity, & HIPAA Rules
OB/GYN billing has to follow the ACA women's preventive services rules for cost-sharing, each state Medicaid program's maternity billing policy, Medicare's own cervical and breast screening codes (G0101, Q0091), and HIPAA.
Fixing Each OB/GYN Billing Gap, One Claim at a Time
Each fix below matches a gap above, in the same order.
Global Package & Split-Care Coding
Our coders decide at delivery whether the global code applies or the care has to be split, and code services outside the package separately when the documentation supports it.
Surgery & Imaging Auth Tracking
We check payer authorization rules for GYN surgery, detailed ultrasounds and genetic testing, submit the request, and track it until the number is on file.
Antepartum Visit Reconciliation
We count antepartum visits from the chart at delivery or transfer and bill 59425, 59426 or E/M codes to match the count.
Preventive & Problem Billing
We code the preventive visit and the problem visit separately, apply modifier 25 when the note supports two services, and flag notes that don't.
Coverage Checks Each Trimester
We verify maternity benefits at the first prenatal visit and re-check coverage each trimester, so a payer change is caught before delivery, not after.
Pre-Submission Ultrasound Review
We check each ultrasound claim for a documented indication and against the payer's per-pregnancy limit before it goes out.
Denials and Appeals
We work each OB/GYN denial to its root cause and appeal the ones that should be paid. Across our denial management work, 79% of denials are overturned, with an average appeal turnaround under 9 days.
Maternity & Preventive Compliance
We track global package billing, modifier 25 use and preventive coding by provider, and flag patterns that would draw a payer review.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
OB/GYN Coding by Service Line
Our coders work every service line an OB/GYN practice bills.
Global OB and Split Billing (59400–59618 series)
Global vaginal, cesarean and VBAC packages, plus antepartum-only, delivery-only and postpartum-only codes for split care.
How We Keep OB/GYN Billing Compliant
Qualigenix keeps OB/GYN billing compliant by applying global obstetric package rules as CPT writes them, separating preventive and problem-oriented care with modifier 25 only when the note supports two services, and following each state Medicaid program's maternity billing policy. Underbilling leaves earned revenue unpaid. Overbilling creates audit exposure and repayment demands. We hold a 98.6% compliance and audit pass rate and an over/undercoding rate under 2%. All work is HIPAA compliant, and patient data is handled under strict security controls.
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Audit Pass Rate
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Variance Threshold
Why Qualigenix
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Reduced Administrative Burden
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Enhanced Compliance
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QUESTIONS BUYERS ASK
Frequently Asked Questions
Qualigenix charges a percentage of collections, so our fee rises and falls with what your practice is paid. We bill all payers, including Medicaid. Call 786-259-0231 for a quote based on your claim volume and payer mix.
Yes. We check each ultrasound for a documented indication, the correct trimester and detail code, and the payer's per-pregnancy limit before the claim goes out.
We follow the maternity billing policy of each state Medicaid program you bill, including its global package rules, modifiers such as TH, and timely filing limits. Commercial plans, including Aetna and Blue Cross Blue Shield plans, publish their own global maternity billing policies, and we apply each plan's version.
Yes. We take over open and aged OB/GYN AR, including unbilled global packages from recent deliveries, and work it alongside new claims. Across our AR work, days in AR have dropped from 54 to 36.
We split the package by date and payer. Antepartum care is billed by visit count (59425, 59426 or E/M codes), and the delivery and postpartum care are billed with delivery-only or postpartum-only codes to the payer that covered the patient on those dates.
Yes, when the note shows a separately identifiable problem-oriented service. We bill the preventive code and the problem visit with modifier 25.
Yes. Qualigenix is system-agnostic and has worked across 133 EMR/EHR platforms, so we work inside your current system.
Our average onboarding takes 6 days, covering system access, payer and Medicaid enrollment checks and a review of your open AR and pending deliveries.