The global maternity package is the largest single bundled payment in obstetric care, covering antepartum, delivery, and postpartum services under one of the global codes (59400 for vaginal delivery, 59510 for cesarean, 59610 for vaginal birth after cesarean, 59618 for cesarean after attempted vaginal delivery). The 2026 Medicare Physician Fee Schedule clarified several documentation expectations around the package, including which antepartum services count toward the global, when to bill antepartum care separately, and how postpartum care timing aligns to the new follow-up windows. For OB/GYN practices, the package is the single most important code to understand correctly. Bundling errors on either side cost meaningful revenue.
What the global package covers
The global maternity package includes antepartum care after the initial confirmatory visit (typically up to 13 routine antepartum visits), the delivery itself, and postpartum care for six weeks after delivery. The package assumes uncomplicated maternity care delivered by the same provider or group. When more than 13 antepartum visits are required for a high-risk pregnancy, additional visits can be billed using the antepartum care codes (59425 for 4 to 6 visits, 59426 for 7 or more visits) outside the global. Practices commonly underbill high-risk pregnancies by leaving the additional visits inside the global, costing 4 to 8 visits worth of revenue per high-risk patient.
When to bill components separately
Several scenarios require billing components separately rather than under the global code. When the same provider does not perform delivery (the patient transferred care or the on-call group attended the delivery), bill the antepartum care code that matches the visit count and the delivery-only code (59409 for vaginal delivery only, 59514 for cesarean only). When the provider does antepartum and delivery but no postpartum (transfer of care after delivery), use 59410 (vaginal delivery including postpartum) or 59515 (cesarean including postpartum) as appropriate. When postpartum is delivered separately by a different provider, bill 59430 alone for that postpartum care.
Problems separable from the global
Conditions and services that are not part of routine maternity care can be billed separately, even within the global period. These include treatment of complications such as hyperemesis gravidarum requiring management, pregnancy-related diabetes management, hypertensive disorders requiring intensive monitoring, fetal monitoring above routine, ultrasounds for medical indications (not routine first or second trimester screening, which are bundled), and unrelated medical or surgical conditions. The audit-defensible approach is a problem-list documentation that distinguishes routine antepartum monitoring from condition-specific management, with separate notes for the separately billable services.
High-risk versus routine
The distinction between high-risk and routine pregnancy drives several billing decisions. Maternal-fetal medicine consultations (76801 ultrasound, 76811 detailed anatomy ultrasound) are billed separately when medically indicated. Non-stress tests (59025), biophysical profiles (76818, 76819), and amniocentesis (59000) for pregnancies with documented risk factors are billed in addition to the global. The defensible documentation for each of these services ties the procedure to a specific risk indication coded in the chart. Practices that bill these services without the supporting risk documentation can see denials under medical necessity review.
Postpartum care timing
The global package includes one postpartum visit (traditionally at six weeks). ACOG and CMS both now recommend a comprehensive postpartum care framework that includes a contact within three weeks of delivery and a comprehensive visit within twelve weeks, particularly for patients with complications, mood disorders, or social risk factors. Some commercial payers and Medicaid programs reimburse for the additional contacts when documented as separate services with appropriate codes. Practices should review payer-specific coverage for extended postpartum care and bill accordingly when the workflow supports it.
Documentation that supports the global claim
Audit-defensible global maternity billing rests on a complete antepartum record that documents each visit count, gestational age at each visit, routine antepartum surveillance findings, and any deviations from routine that triggered separately billable services. The delivery note documents the delivery type (vaginal, operative vaginal with vacuum or forceps, cesarean), any complications, and the immediate postpartum status. The postpartum note documents the comprehensive visit content. Practices that submit the global code with only a delivery note in the chart will face denials and recoupment requests.
How MHB helps OB/GYN practices
For OB/GYN practices that want specialty-trained coders working their global maternity claims with high-risk separation, postpartum extension billing, and ultrasound coding aligned to medical necessity, our team supports specialty medical coding for obstetrics and gynecology. The work runs in the practice’s existing EHR.
The bottom line
The global maternity package is unforgiving. Bundling too aggressively leaves antepartum and ultrasound revenue inside the global. Unbundling without documentation triggers denials. Practices that document visit counts, risk indications, and condition-specific management as they go capture full revenue and pass audit review. Practices that bill the global code as a default lose money on their highest-acuity patients.
Authoritative sources
This article cites the following primary sources for billing-code and regulatory guidance. Always confirm current rules and codes with the publishing authority before applying to a specific claim.
