CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP044

Global Obstetrical/OB Maternity Services Policy

Governs reimbursement and coding for global obstetrical/maternity professional services (antepartum, delivery, postpartum) for Blue Cross Blue Shield of Oklahoma members and affected providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyGlobal Obstetrical/OB Maternity Services Policy

Policy CodePolicy CPCP044

Change TypeNo material change

Effective DateAugust 19, 2025

Next Review DateN/A

Key ActionSubmit supporting documentation upon request and ensure claims are coded and documented accurately.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

59400/59510Primary global OB CPT examples

13Antepartum visit threshold

0500F/0501F/0503FCategory II quality codes

59514C-section assistant eligible code

5Related policies listed

Coverage Criteria for Global Obstetrical/Maternity Services

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Coverage criteria for global OB and component services

Rules for when global OB may be billed and when separate billing is appropriate.

Global OB may be billed when the same qualified health care professional (QHP) or another QHP practicing at the same location reporting under the same Federal Tax Identification Number provides the antepartum, delivery and postpartum care. A global OB charge should only be billed when all maternity-related services are provided by those same reporting entities.

Global OB package includes specified antepartum visits, delivery services, and postpartum care for CPT codes 59400 (vaginal delivery) and 59510 (cesarean delivery).

When NOT to bill global OB

If the provider provides antepartum and/or postpartum care but does not perform the delivery, report antepartum-only or postpartum-only codes (59425, 59426, 59430) with units based on visit counts (e.g., 59425 for 4–6 visits; 59426 for 7+ visits).
Initial pregnancy confirmation visit is not part of antepartum care when the OB record is not initiated; it may be reported separately.

Assistant surgeon reimbursement

Assistant surgeon reimbursement is allowed only when a non-global C‑section delivery-only code (59514) is submitted with the appropriate assistant surgeon modifier.
Reimbursement for the assistant surgeon is paid at a percentage of the primary physician's contracted rate.

High‑risk visit threshold

High‑risk members who are seen for more than 13 antepartum visits may have additional visits reported in addition to the global services; documentation must support medical necessity and any additional testing performed.
Members who are only 'at risk' (history of prior pregnancy problems) without additional visits do not qualify for additional charges beyond the global package.

Services that may be reported in addition to global OB

Pregnancy confirmation visit when the OB record is not initiated.
Antepartum diagnostic/procedural services such as amniocentesis/cordocentesis (59000–59012), chorionic villus sampling (59015), diagnostic ultrasounds (76801–76828), external cephalic version (59412), fetal biophysical profile (76818–76819), and fetal testing (59020, 59025).
Labor and delivery services provided more than one calendar day prior to delivery for complications (E/M facility services), insertion of a cervical dilator prior to hospital admission, and repair of third‑ or fourth‑degree perineal laceration.

Providers are responsible for accurate, complete, and legible documentation of services performed and should submit supporting documentation upon request.

Global OB billing and quality reporting criteria

Billing and reporting requirements for global maternity care and quality measurement

Services unrelated to the member's pregnancy that are provided by the provider rendering global maternity care must be documented and reported separately with the appropriate E/M code and/or modifier(s), with the unrelated condition listed as the primary diagnosis.

Providers are encouraged to report initial and postpartum visits with CPT Category II quality measure codes when applicable: 0500F or 0501F for the initial/prenatal visit and 0503F for the postpartum visit. Include the actual date the postpartum service was rendered on the claim when reporting 0503F.

When applicable, include date of last menstrual period (LMP) information in Box 14 of the CMS‑1500 claim form as part of quality measurement reporting.

Claims for the global OB package should be submitted upon delivery. Providers should follow related Clinical Payment and Coding Policies (e.g., CPCP006, CPCP010, CPCP015, CPCP023, CPCP043) for additional billing and coding guidance.

Coding and Billing Details

Selected CPT / Category II codes referencedCPTCovered

59400	Global vaginal delivery (includes antepartum, delivery, postpartum)
59510	Global cesarean delivery (includes antepartum, delivery, postpartum)
59425	Antepartum care only, 4-6 visits
59426	Antepartum care only, 7+ visits
59430	Postpartum care only
59514	C-section delivery-only (eligible for assistant surgeon reimbursement)
0500F	Category II prenatal care quality measure
0501F	Category II prenatal care flow sheet quality measure
0503F	Category II postpartum visit quality measure

Recommended quality measure Category II codesCPTCovered

0500F	CPT Category II - Quality measure: prenatal care
0501F	CPT Category II - Quality measure: prenatal care flow sheet
0503F	CPT Category II - Quality measure: pregnancy (postpartum)

Antepartum visit threshold for additional billing

Antepartum visit thresholdMore than 13 antepartum visits may be reported in addition to the global services for high-risk members; documentation must support medical necessity.

High-risk definitionHigh-risk: member has problems in current pregnancy and may be seen more frequently; additional visits billable only if >13 antepartum visits.

At-risk guidanceAt Risk: prior pregnancy problem but no current issues — if no additional visits are needed, no additional charges may be submitted.

Documentation requirementDocumentation must reflect necessity of additional visits and any additional laboratory or radiologic tests performed.

Provider Actions and Documentation Requirements

Documentation Required

Documentation and Requests

Providers are responsible for submission of accurate documentation of services performed and for maintaining accurate medical records. BCBSOK may request supporting documentation at any time; providers should submit additional documentation upon request. Claims are subject to code edit protocols and review for benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Providers are expected to submit claims using valid code combinations from HIPAA-approved code sets and to code according to industry-standard guidelines (for example, Uniform Billing, AMA CPT, CPT Assistant, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidelines, CMS NCCI Policy Manual and CCI edits). Upon request, the provider is urged to submit any additional documentation to support the services billed.

Providers must keep accurate records and are responsible for documentation supporting services rendered.
BCBSOK may request supporting documentation; providers should promptly supply requested records to avoid delays or claim denial.
Claims are subject to claim review and code-edit protocols; appropriate coding guidelines must be followed.

Billing Rule

Reporting Services Unrelated to Pregnancy

When a provider who is rendering global maternity care also performs services that are unrelated to the member’s pregnancy, those unrelated services must be documented and reported separately. Report the unrelated service with the appropriate E/M CPT code and any applicable modifier(s), and use the condition unrelated to the pregnancy as the primary diagnosis code. Ensure the claim supports that the service was distinct from routine prenatal/global maternity care to avoid bundling denials.

Report unrelated services with the appropriate E/M code(s).
Include any applicable modifier(s) to indicate services separate from the global maternity package.
Use the unrelated condition as the primary diagnosis code on the claim.
Maintain documentation showing the service was distinct from pregnancy-related care.

Definitions

Global OB package

DefinitionGlobal OB may be billed when the same qualified health care professional (QHP) or another QHP at the same location reporting under the same Federal Tax Identification Number provides antepartum, delivery, and postpartum care.

Included services — AntepartumInitial and subsequent history; physical exams following initial pregnancy diagnosis; weight, blood pressure, fetal heart tones, routine dipstick urinalysis; routine visits (monthly to 28 wks, biweekly to 36 wks, weekly after 36 wks).

Included services — DeliveryAdmission to hospital, admission history and physical, management of uncomplicated labor (including induction, insertion of cervical dilator on day of delivery, simple cerclage removal), vaginal or cesarean delivery, delivery of placenta, routine inpatient care immediately after delivery.

Included services — PostpartumHospital and office visits following a vaginal or C-section delivery.

VBAC

DefinitionVBAC: Vaginal delivery after previous cesarean delivery.

Relevant codes — VBAC global59610: Global vaginal delivery after VBAC; 59618: Global C-section after VBAC (see policy for full code usage).

Vaginal delivery-only VBAC codes59612: VBAC delivery only; 59614: VBAC including postpartum.

Services Unrelated to Pregnancy

DefinitionServices unrelated to pregnancy are services provided by the global maternity provider that are not related to the member's pregnancy.

Billing guidanceSuch services should be documented and reported separately with the appropriate E/M code and/or modifier(s), using the unrelated condition as the primary diagnosis code.

Provider responsibilityThe provider rendering global maternity care must ensure separate documentation and correct coding to support reimbursement for unrelated services.