CurrentBlue Cross Blue Shield - TexasPolicy CPCPO44

Global Obstetrical/OB Maternity Services Policy

Governs billing, coding, and reimbursement for global obstetrical/maternity services (antepartum, delivery, postpartum) for providers submitting professional claims to Blue Cross Blue Shield - Texas.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyGlobal Obstetrical/OB Maternity Services Policy

Policy CodePolicy CPCPO44

Change TypeNew policy

Effective DateAugust 19, 2025

Next Review Date

Key ActionDocument and report services unrelated to pregnancy separately with the appropriate E/M code and modifier(s) using the non-pregnancy condition as the primary diagnosis.

SourceLink

POLICY UPDATE CHANGES

New policy created on 05/09/2025.

59400, 59510Primary delivery codes referenced

13Antepartum visit threshold

59514C-section assistant eligible code

3Category II quality codes

5Related policy cross-references

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Coverage Criteria

COVERAGE CRITERIA — Global OB Package

Global OB package includes antepartum, delivery, and postpartum care. Claims for the global package should be submitted upon delivery. Services unrelated to pregnancy that are provided by the global maternity care provider must be documented and reported separately.

ALL of the following

Antepartum care: initial and subsequent history and physical examinations following the initial diagnosis of pregnancy; obtaining and recording of weight; blood pressure; fetal heart tones; routine dipstick urinalysis; monthly routine visits up to 28 weeks gestation (typically 5–6 visits); biweekly routine visits to 36 weeks gestation (typically 4 visits); weekly routine visits after 36 weeks until delivery (typically 3–4 visits).
Delivery services: admission to the hospital; admission history and physical examination; management of uncomplicated labor including induction of labor; insertion of cervical dilator; simple removal of cerclage; vaginal delivery (with or without episiotomy, with or without forceps) or cesarean delivery; delivery of the placenta; routine inpatient care immediately after the delivery day.
Postpartum care: hospital and office visits following a vaginal or cesarean delivery as part of the global package.
Included CPT codes: global OB package typically applies to CPT 59400 (vaginal delivery) and CPT 59510 (cesarean delivery).

Billing and Quality Reporting Requirements — When submitting global maternity (OB) package claims:

When submitting global maternity (OB) package claims, certain services may be reported separately and quality measurement reporting is encouraged.

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Coding

Primary global maternity delivery codesCPTCovered

59400	Global vaginal delivery
59409	Vaginal delivery only
59410	Vaginal delivery with postpartum
59510	Global C-section
59514	C-section delivery only

Primary global maternity delivery codes - additional VBAC/C-section variants referencedCPTCovered

59610	Global vaginal delivery, after VBAC
59612	VBAC delivery only
59614	VBAC including postpartum
59515	C-section delivery only including postpartum
59618	Global C-section after VBAC
59620	C-section delivery only after VBAC
59622	C-section delivery only after VBAC including postpartum

Antepartum/postpartum separately billable codes when delivery performed by different providerCPTCovered

59425	Antepartum care only (1-3 visits)
59426	Antepartum care only (4-6 visits)
59430	Postpartum care only

Examples in narrative showing units/usageCPTCovered

59410

Vaginal delivery with postpartum (used by provider who performs delivery and postpartum)

Examples of separately reportable services and quality codesmixedCovered

59000-59025	Amniocentesis, cordocentesis, chorionic villus sampling, fetal testing (examples listed 59000-59025)
76801-76828	Diagnostic ultrasounds (maternal and fetal)
59412	External cephalic version
76818-76819	Fetal biophysical profile
59020,59025	Fetal stress test and fetal non-stress test
99415-99418	Prolonged physician services (add-on) — not separately reimbursable for labor and delivery per policy

Labor and delivery procedure examplesmixedCovered

(repair 3rd/4th degree laceration)	Repair of a third- or fourth-degree perineal laceration (listed as separately reportable procedure)
(insertion cervical dilator)	Insertion of a cervical dilator by the provider prior to hospital admission (listed as separately reportable)

CPT Category II OB quality measure codesCPTCovered

0500F	Initial prenatal care (Category II quality measure)
0501F	Prenatal care flow sheet (Category II quality measure)
0503F	Postpartum visit (Category II quality measure)

Quality reporting guidanceCPT

Box 14

Date of LMP — include in Box 14 of the CMS 1500 Claim Form as instructed

Antepartum visit reporting threshold

ThresholdAdditional visits may be reported only if the patient is seen for more than 13 antepartum visits (high-risk)

Definition of High-RiskMember has problems in current pregnancy and may require >13 antepartum visits

At-Risk guidanceMember had a problem with a previous pregnancy but if no issues develop during the current pregnancy, no additional charges may be submitted

Date of LMP

Claim form fieldInclude date of last menstrual period (LMP) in Box 14 of the CMS 1500 Claim Form

When to includeWhen applicable to the global OB package claim and quality reporting

PurposeSupports prenatal quality measurement reporting and accurate claim adjudication

Provider Actions & Billing Guidance

Documentation Required

Documentation Request

The Plan reserves the right to request supporting documentation to determine eligible reimbursement. Failure to adhere to coding and billing policies may impact claims processing and reimbursement. Submission of any code should be fully supported in the medical documentation. Providers are urged to submit any additional documentation upon request to minimize delays in claims processing.

Submission should include documentation supporting the service, diagnosis, and medical necessity.
Claims are subject to claim review, code edit protocols, and applicable plan/contract terms.

Note

Conflict Resolution / Discretion

If a conflict arises between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. If a conflict arises between this policy and a provider contract pursuant to which a provider participates in and/or provides Covered Services to eligible members and/or plans, the provider contract will govern. Plan documents include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. Blue Cross Blue Shield of Texas may use reasonable discretion in interpreting and applying this policy to services delivered in a particular case; BCBSTX has full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents.

When plan documents or provider contracts differ from this policy, follow the governing document as specified above.
BCBSTX may apply discretion when interpreting or applying the policy to individual cases.

Billing Rule

Billing of Unrelated Services During Global Maternity Care

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

Report unrelated services separately from the global OB package.
Use appropriate E/M codes and modifiers to identify non-pregnancy care.

Note

Quality Measure Reporting for Prenatal/Postpartum Visits

Providers are encouraged to report CPT Category II quality measure codes in addition to the global OB package claim when applicable: Initial visit — 0500F or 0501F (prenatal care); Postpartum visit — 0503F (postpartum care). Include date of LMP in Box 14 of the CMS-1500 when available.

Initial visit: CPT Category II 0500F or 0501F (prenatal care).
Postpartum visit: CPT Category II 0503F (postpartum care).
Include date of LMP in Box 14 of the CMS-1500 claim form.

Definitions

Global OB charge

DefinitionGlobal OB charge: A single charge billed when antepartum, delivery, and postpartum care are all provided by the same qualified health care professional or another QHP at the same location under the same TIN.

Who may billThe provider who rendered all maternity-related services or another QHP practicing at the same location reporting under the same Federal Tax Identification Number

ScopeIncludes routine antepartum visits, delivery services (admission, management of uncomplicated labor, delivery of infant and placenta) and postpartum care when all are provided by the same billing entity

High-Risk vs At Risk

High-RiskMember has problems in current pregnancy and may require more than 13 antepartum visits; additional visits may be reported when exceeded

At RiskMember had a problem with a previous pregnancy but if no issues develop during the current pregnancy, no additional visits or charges should be submitted

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

Services Unrelated to Pregnancy

Separate billingServices unrelated to the member's pregnancy provided by the global maternity care provider should be documented and reported separately with the appropriate E/M code and/or modifier(s)

Primary diagnosisUse the non-pregnancy condition as the primary diagnosis code when billing unrelated services

DocumentationProvider must document the unrelated service and support separate billing in the medical record

Quality Measure Codes (CPT II)

Recommended CPT Category II codes0500F, 0501F, 0503F are referenced for prenatal and postpartum quality measurement reporting

Initial visit reportingSubmit initial prenatal visit with CPT Category II code 0500F or 0501F when applicable

Postpartum visit reportingSubmit postpartum visit with CPT Category II code 0503F using the actual date the postpartum service was rendered