ModifiedUnitedHealthcarePolicy N/A

Global obstetrical (OB) reimbursement and itemization of maternity care services

Defines UnitedHealthcare Community Plan Medicaid reimbursement rules for global OB codes, itemization of antepartum/delivery/postpartum services, billing practices (including state exceptions), and when services are payable separately. Applies to services billed on CMS-1500 forms for UnitedHealthcare Community Plan Medicaid products.

Policy Summary

PayerUnitedHealthcare

PolicyGlobal obstetrical (OB) reimbursement and itemization of maternity care services

Policy CodePolicy N/A

Change TypeMaterial updates (state exceptions and subsection revisions)

Effective DateN/A

Next Review DateN/A

Key ActionAppend modifier 24 to non-OB related office E/M services rendered during the postpartum stage for reimbursement.

SourceLink

POLICY UPDATE CHANGES

North Carolina was added to the State Exceptions section.

Antepartum Care Only subsection was updated.

Delivery Services Only subsection was updated.

59400,59510,59610,59618Global OB codes

60 daysPostpartum period

First 3 visitsAntepartum visits excluded

59425/59426Antepartum-only codes

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

48 units/yrDoula unit limit

Z3AGestational age code requirement

Coverage and Reimbursement Criteria

CPT, HCPCS and ICD-10 Coding Guidance

Global OB codesCPTCovered

59400	Global OB office or outpatient prenatal care, delivery and postpartum care (vaginal)
59510	Global OB package for cesarean delivery
59610	Global OB package for vaginal delivery after previous cesarean
59618	Global OB package for cesarean delivery after previous cesarean

Itemization and component codesCPTCovered

59425	Antepartum care only (4-6 visits)
59426	Antepartum care only (7+ visits)
59409	Delivery only (vaginal)
59514	Delivery only (cesarean)
59612	Delivery only (vaginal after prior cesarean)
59620	Delivery only (cesarean after prior cesarean)
59430	Postpartum care only
59410	Delivery including postpartum care (vaginal)
59515	Delivery including postpartum care (cesarean)
59614	Delivery including postpartum care (vaginal after prior cesarean)

1–10 of 11

1/2

Ultrasound codes excluded from global packageCPTCovered

76801-76817, 76820-76828

Obstetric ultrasound codes (maternal or fetal echography) — excluded from global package and may be separately reported

Fetal NST codingCPTCovered

59025

Fetal non-stress test; initial test

Assistant surgeon cesarean codesCPTCovered

59514	Cesarean delivery only (non-global) — reimbursable with assistant surgeon modifier
59620	Repeat cesarean delivery only (non-global) — reimbursable with assistant surgeon modifier

OB global and antepartum coding rulesCPT

59400	Global OB delivery (allowed for freestanding birthing centers in OH)
59425	Antepartum care only (not reimbursed for home/non-facility in many instances; E/M required)
59426	Antepartum care only (not reimbursed for home/non-facility in many instances; E/M required)
59409	Delivery codes (specific state notes re: billing/forms and modifiers)
S9445	State-specific service code referenced (Tennessee note)
S9446	State-specific service code referenced (Tennessee note)

Doula codesHCPCSCovered

T1032	Services performed by a doula birth worker, per 15 minutes
T1033	Services performed by a doula birth worker, per diem

ICD-10 gestational week codes requirementICD-10Covered

Z3A.*

Gestational age diagnosis codes (required on delivery claims)

OB-related diagnosis codesICD-10

No codes listed

Antepartum visit thresholds for antepartum-only codes

Antepartum-only code 59425Use when 4-6 antepartum visits are provided; report one unit with from/to dates for the range covered.

Antepartum-only code 59426Use when 7 or more antepartum visits are provided; report one unit with from/to dates for the range covered.

1-3 antepartum visitsIf only 1-3 visits are provided, itemize each E/M visit rather than reporting 59425/59426.

Claim submission detailsReport a single unit for 59425/59426 and include the date range ('from' and 'to') covered by the antepartum visits.

multiple procedure reductions

Multiple procedure reductions policyMultiple procedure reductions will be applied to OB codes having a delivery component for both vaginal and cesarean sections.

ScopeApplies to OB codes with a delivery component (vaginal and cesarean).

ReferenceSee UnitedHealthcare Community Plan's Multiple Procedure Policy for application details and reduction percentages.

T1032 annual unit limit

T1032 annual unit limitT1032 (doula per 15 minutes) is reimbursable without prior authorization up to 48 units per year.

T1033 reimbursement timingT1033 (doula per diem) is reimbursable for services provided on the date of delivery.

Doula service periodDoula services are reimbursable beginning in the prenatal period and continuing up to 365 days postpartum, contingent on member eligibility.

Billing, Documentation and Provider Requirements

Billing Rule

Fetal Non‑Stress Test Repeat Coding

Per CPT guidelines, multiple non-stress tests (NST) performed on the same fetus on the same day are billed with CPT code 59025 for the initial test. Repeated tests by the same physician should append modifier 76; repeated tests by a different physician should append modifier 77. For twin gestations, report the initial test for the first fetus as 59025; subsequent testing on that same fetus as 59025-76 (or -77). For the second fetus, report the initial test as 59025-59 to indicate a separate fetus; subsequent tests on the second fetus should be 59025-59-76 (or -59-77). Include sufficient documentation to support repeated testing when applicable.

Initial NST: CPT 59025
Repeat by same physician: CPT 59025 with modifier 76
Repeat by different physician: CPT 59025 with modifier 77
Second fetus in twins: CPT 59025 with modifier 59; repeats use 59 plus 76 or 77

Definitions and Terms

Same Group Physician definition

DefinitionAll physicians and/or other qualified health care professionals of the same group reporting the same Federal Tax Identification (or federal tax identification) number.

Implication for billingWhen all components of the OB package are provided by the Same Group Physician/Qualified Health Care Professional, report the global OB package code.

DistinctionSame Group relates to group/TIN; 'Same Individual' refers to the identical rendering provider (same individual reporting the same TIN).

Global OB package definition

DefinitionThe total obstetric package includes the provision of antepartum care, delivery, and postpartum care (per AMA).

When to report global codeReport the global OB package code when the Same Group Physician and/or Other Qualified Health Care Professional provides all components of the OB package.

Policy Version Changes

2026-02-01annual_reviewLatest

Annual review and version update; history entries prior to 2024-02-01 archived.

2025-11-18policy_version_change

State Exceptions section updated for Wisconsin; history entries prior to 2023-11-18 archived.

2025-09-19policy_version_change

Policy Summary

PayerUnitedHealthcare

PolicyGlobal obstetrical (OB) reimbursement and itemization of maternity care services

Policy CodePolicy N/A

Change TypeMaterial updates (state exceptions and subsection revisions)

Effective DateN/A

Next Review DateN/A

Key ActionAppend modifier 24 to non-OB related office E/M services rendered during the postpartum stage for reimbursement.

SourceLink

On This Page

Prior Authorization

Doula Services Billing and Prior Authorization

Providers must bill doula services using the appropriate HCPCS codes: T1032 (doula services, per 15 minutes) or T1033 (doula services, per diem). Doula services are reimbursable without prior authorization up to 48 units per year for T1032. T1033 is reimbursable for services provided on the date of delivery. Doula services may be provided in the community, provider office, acute care facilities, and via telehealth; append modifier GT when billing for telehealth doula services. Coverage may extend from the prenatal period through postpartum (up to 365 days) where applicable and contingent on member eligibility.

Bill using T1032 (per 15 minutes) or T1033 (per diem)
T1032 reimbursable without prior authorization up to 48 units/year
T1033 reimbursable for date of delivery services
Append modifier GT for telehealth doula services
Services may be covered beginning prenatally and continuing up to 365 days postpartum subject to member eligibility

Billing Rule

Separate Payment for Unrelated Critical Care During Global Period

Critical care services that are unrelated to the procedure during the global surgical period may be paid separately in addition to the global OB package. Payment is considered when the patient is critically ill, requires the full attention of the physician, and the critical care is above and beyond and unrelated to the specific anatomic injury or surgical procedure. When billing for an unrelated critical care service during the global period, append modifier FT to the procedure.

Critical care unrelated to the procedure may be billed separately during the global period
Service must meet definition of critical care and be unrelated to the procedure
Append modifier FT when critical care is unrelated to the procedure

CPT global OB codesCPT codes identified as global OB codes: 59400, 59510, 59610, 59618.

Non-OB E/M Services definition

DefinitionE/M visits for conditions unrelated to pregnancy (e.g., bronchitis, flu) during the antepartum stage; reimbursable when the diagnosis code clearly identifies the condition as not related to pregnancy.

Documentation requirementThe diagnosis used with the E/M service must support that the condition is not related to pregnancy care.

Billing contextThese services can be reported as they occur and are considered Non-OB E/M Services separate from routine antepartum care.

Modifier 24 definition

DefinitionModifier 24 indicates a non‑OB related E/M service performed during the postpartum period that is unrelated to the global OB package or delivery.

Use caseAppend modifier 24 to non-OB related office E/M services rendered during the postpartum stage for reimbursement.

Relation to documentation/reviewClaims for multiple gestation deliveries are reviewed and other modifier uses (e.g., 22) require supporting documentation as described elsewhere in policy.

Modifier 22 definition

DefinitionModifier 22 indicates increased procedural services and may be appended to delivery/global codes when physician work is substantially greater than usual (e.g., repair of 3rd/4th degree laceration, increased work for second twin).

Documentation requirementClaims submitted with modifier 22 must include medical record documentation supporting the use of the modifier and are subject to individual review per the Increased Procedural Services policy.

Review processClaim submissions for multiple gestation deliveries with modifier 22 are reviewed by the Medical Claim Review unit.

Non-Obstetric E/M Service

DefinitionVisit(s) occurring outside the regularly scheduled antepartum period for conditions unrelated to routine antepartum care; provided by the Same Group Physician and/or Other Qualified Health Care Professional.

ExamplesConditions such as bronchitis, flu, or upper respiratory infection occurring during pregnancy are Non-Obstetric E/M Services when unrelated to pregnancy.

BillingThese visits are reported and reimbursed independently of the global antepartum package when the diagnosis supports a non-OB condition.

Obstetric (OB) Related E/M Service

DefinitionAdditional antepartum visits provided in addition to routine antepartum care for a high-risk or complicated pregnancy (beyond routine visits).

When separate from global careOB-related E/M services that represent additional medically necessary care beyond routine antepartum visits may be itemized when diagnosis and documentation support the need.

Distinction from Non-OB E/MThese visits are related to pregnancy complications and differ from Non-OB E/M services which are for unrelated conditions.

Same Group Physician and/or Other Qualified Health Care Professional (duplicate entry)

DefinitionAll physicians and/or other qualified health care professionals of the same group reporting the same Federal Tax Identification number; used to determine whether services are billed as part of the global package.

Billing impactWhen services are provided by the Same Group Physician/Qualified Health Care Professional, the global OB code applies and component services are generally not separately reimbursable.

ContrastIf services are provided by a different group or outside the Same Group, itemization or non-global codes (e.g., 59425/59426/59409) may be appropriate per policy rules.

global package (definition / examples)

Global package definitionThe global package is the total obstetric package (antepartum, delivery, postpartum) and includes services considered part of routine maternity care per AMA/ACOG guidance.

Examples of included servicesAntepartum visits (routine), delivery services, and postpartum care are components of the global package and are not separately reimbursed when billed by the Same Group Physician/Qualified Health Care Professional.

Examples not separately reimbursableContraceptive educational consultations, lactation/infant safety/birthing/parenting classes are considered part of the global package and not separately reimbursed when submitted by the Same Group Physician/Qualified Health Care Professional.

critical care (in context of global period)

Definition of critical care in global period contextCritical care is care for a patient who is critically ill and requires the full attention of the physician; when unrelated to the surgical procedure, it may be paid separately in addition to the procedure.

Modifier requirementWhen the critical care service is unrelated to the procedure within a global surgical period, append modifier FT to indicate unrelated critical care.

Payment conditionSeparate payment is allowed only if the critical care is above and beyond and unrelated to the specific anatomic injury or general surgical procedure performed during the global period.

Antepartum Care Only subsection updated; State Exceptions section updated for Wisconsin.

2025-08-31policy_version_change

State Exceptions section updated for Florida.

2025-08-24policy_version_change

State Exceptions section updated for Florida.

2025-07-13policy_version_change

State Exceptions section: California removed.

2025-07-01policy_version_change

North Carolina added to the State Exceptions section.

2025-05-23policy_version_change

State Exceptions section updated for Arizona; history entries prior to 2023-05-23 archived.

2025-03-14policy_version_change

Delivery Services Only subsection updated; history entries prior to 2023-03-14 archived.

2025-03-09policy_version_change

State Exceptions section updated for Florida.

2024-12-24policy_version_change

State Exceptions section updated for Wisconsin.

2024-11-27policy_version_change

State Exceptions section updated for Indiana; history entries prior to 2022-11-27 archived.

2024-10-06policy_version_change

State Exceptions section updated for Missouri.

2024-10-04policy_version_change

State Exceptions section updated for Ohio; history entries prior to 2022-10-04 archived.

2024-09-15policy_version_change

State Exceptions section updated for Kansas.

2024-07-12policy_version_change

State Exceptions section updated for Pennsylvania.

2024-04-14policy_version_change

State Exceptions section: Rhode Island added.

2012-02-12policy_implemented

Policy implemented by UnitedHealthcare Community & State.