Global package includes antepartum, delivery, and postpartum services for uncomplicated maternity cases and these are bundled and not separately reimbursable.
Antepartum services included: initial and subsequent history and physical examinations; routine prenatal visits (approximately 13 for uncomplicated pregnancy with monthly visits to 28 weeks, biweekly to 36 weeks, and weekly until delivery); recording of weight, blood pressure, fetal heart tones, and routine chemical urinalysis; and any E/M services related to pregnancy during the antepartum period are included and not reported separately.
Delivery services included: admission to labor and delivery with history and physical, management of uncomplicated labor including fetal monitoring, vaginal delivery (with or without episiotomy, forceps, or vacuum) or cesarean delivery, delivery of the placenta by any method, placement of internal fetal and/or uterine monitors, catheterization, perineal preparation, injection of local anesthesia, administration of intravenous oxytocin (96365-96367), exploration of the uterus, placement of a hemostatic pack or agent, simple removal of cerclage (not under anesthesia), and discussion/consent for contraception. These are part of the global OB package and not separately reimbursable unless a state regulation, contractual agreement, or health plan policy allows an exception.
Postpartum services included: recovery room visit, uncomplicated inpatient and outpatient postpartum visits, and discussion of contraception (including prescription when appropriate). Routine postpartum care is part of the global package and not separately billed.
Services that may be reported separately from the global package: management of inpatient or outpatient medical problems not related to pregnancy; management of inpatient or outpatient complications related to pregnancy when they warrant treatment of higher complexity and additional visits beyond the normal number; management of surgical problems arising in the postpartum period; and procedures such as tubal ligation or IUD insertion (procedures separately payable though related E/M for discussion/consent is included in the global service).
Reporting guidance and documentation expectations: when other services billed indicate a diagnosis/condition unrelated to maternity, or complications that require higher complexity care or visits beyond typical allowance, documentation (including up to a 60-day history review) must support separate reporting; clinical validation and code auditing will determine appropriate payment or denial for unbundling.
Third- or fourth-degree laceration repair guidance: ACOG recommends reporting appropriate integumentary CPT codes for repair of severe perineal lacerations; consider appending modifier -22 to the delivery code when additional procedural work is substantial and provide supporting documentation when modifier -22 is used.
Multiple gestation guidance: follow CPT and ACOG guidance for reporting multiple gestation deliveries (e.g., reporting for Twin A and Twin B, use of modifiers as appropriate); if only part of the obstetric package is provided based on gestational age, code accordingly (e.g., codes for abortion prior to 20 weeks, or global obstetric code after 20 weeks).