OB/GYN Billing Guide: 2026 CPT Codes, the 2027 Maternity Change and NCCI Rules

• 2026 deliveries are still billed as global packages (59400, 59510, 59610, 59618) when one practice provides all the care.
• Split care is billed in pieces: antepartum by visit count, delivery-only, delivery plus postpartum, or postpartum-only codes.
• Ultrasound, amniocentesis and high-risk extra visits are outside the package and billed separately.
• On January 1, 2027 the global codes are deleted and maternity care is reported in four phases.
• Pelvic exams, exam under anesthesia and confirmatory colposcopy are included in the gynecologic procedure they precede.
• G0101 with a problem visit needs unrelated work and modifier 25 on the E/M.

When one physician or group provides the antepartum care, the delivery and the postpartum care, the whole episode is billed with one code after delivery. The code is chosen by delivery route and prior cesarean history.

What NCCI includes and excludes

When the package splits

The AMA’s CPT 2027 maternity FAQ describes the change: instead of one global code for about nine months of care, maternity care is reported by service in four phases. Antepartum and postpartum care are reported per E/M encounter, labor management is reported daily, and delivery codes cover delivery care only.

Pregnancies that span the change

The NCCI rules that decide most gynecology denials

Medicare uses two HCPCS codes for this screening: G0101 for the screening pelvic and clinical breast exam and Q0091 for obtaining, preparing and sending the screening Pap specimen. Medicare.gov gives the frequency: once every 24 months in most cases, once every 12 months for patients at high risk or of child-bearing age with an abnormal Pap in the past 36 months, and HPV testing with the Pap once every five years for patients 30 to 65 without HPV symptoms. With assignment, the patient pays nothing for the Pap, HPV test, specimen collection or the pelvic and breast exams.

When a screening and a problem visit happen together, the 2026 NCCI manual (chapter XII) is specific: if the covered E/M requires the breast or pelvic exam, G0101 is not added. If the E/M and the screening are unrelated, both are reported with modifier 25 on the E/M.

NCCI chapter VII §B applies the global surgery rules. For a 090-day major procedure, an E/M on the same day that decided to operate is billable with modifier 57; other preoperative visits that day are included. For a 000 or 010-day minor procedure, the decision to perform it is included, and only a significant, separately identifiable E/M unrelated to that decision is billable with modifier 25. Different diagnoses are not required, and a new patient alone does not justify the visit. During a postoperative period, an E/M for an unrelated problem uses modifier 24.

Correcting and appealing these with the visit log, the operative note and the right modifier is what our denial management service does. ACOG publishes coding guidance for members in its coding and billing resources.

• Medicare NCCI Policy Manual 2026, Chapter VII: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems (revision date January 1, 2026; read November 9, 2026)
• Medicare NCCI Policy Manual 2026, Chapter XII: Supplemental Services (revision date January 1, 2026)
• AMA, FAQs: CPT 2027 Maternity Care Services code changes (updated September 17, 2026)
• AMA, FAQs: CPT 2027 coding maternity care spanning the transition date (November 5, 2026)
• Medicare.gov, Cervical and vaginal cancer screenings (read November 9, 2026)
• CMS fact sheet: CY 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F) (October 31, 2025)
• CMS fact sheet: CY 2027 Medicare Physician Fee Schedule final rule (November 4, 2026)
• American College of Obstetricians and Gynecologists, coding and billing (member resource; read November 9, 2026)

CPT codes and descriptors are from the AMA CPT code set. This guide does not state fee amounts; check your Medicare contractor’s fee schedule, your state Medicaid fee schedule and your payer contracts.

What is included in the global obstetric package?

The 2026 NCCI manual (chapter VII §G) says the total obstetric packages such as 59400 and 59510 include antepartum care, the delivery and postpartum care. Fetal monitoring during labor (59050, 59051), episiotomy (59300), delivery of the placenta (59414) and antepartum urinalysis are included and not billed separately.

What is not included in the global OB package?

Ultrasound, amniocentesis, special screening tests for genetic disorders, visits for conditions unrelated to the pregnancy, and additional frequent visits because of high-risk conditions are outside the total obstetric package under NCCI chapter VII §G.1. Those services are billed separately when documented.

How do I bill antepartum care when the patient transfers?

For 2026 visits, when one practice does not provide the whole package: one to three antepartum visits are billed as individual E/M codes, four to six visits as 59425, and seven or more as 59426. The delivering practice bills a delivery-only or delivery-plus-postpartum code instead of the global code.

What changes in maternity coding on January 1, 2027?

The AMA is replacing the nine-month global package with codes that report four phases separately: antepartum, labor management, delivery and postpartum. Seventeen codes are deleted, including 59400, 59510, 59610, 59618, 59425 and 59426; twelve are added; six are revised. Antepartum and postpartum care move to per-encounter E/M reporting.

How do I code a December 2026 delivery with postpartum care in 2027?

Per the AMA's transition FAQ, a delivery in 2026 is still reported with the 2026 global code (for example 59400) even if postpartum care happens in 2027. Postpartum services on or after January 1, 2027 could be reported with the appropriate E/M code. Check each payer for its own transition policy.

Can colposcopy be billed with a LEEP or other cervical procedure?

Not when the colposcopy only confirms the lesion or assesses the field before the procedure. NCCI chapter VII §E.5 says a diagnostic colposcopy that leads to the decision to perform a non-colposcopic procedure may be reported, with modifier 58 on the non-colposcopic procedure, and diagnostic colposcopies are not reported with other colposcopic procedures.

Can G0101 be billed with a problem visit?

Only when the visit and the screening are unrelated. The 2026 NCCI manual (chapter XII) says G0101 is not reported in addition when a covered E/M service requires the breast or pelvic exam. When the two are unrelated, both are reported with modifier 25 on the E/M code.

How often does Medicare cover a screening Pap test?

Once every 24 months in most cases, and once every 12 months for patients at high risk or of child-bearing age with an abnormal Pap test in the past 36 months. HPV testing with the Pap test is covered once every five years for patients aged 30 to 65 without HPV symptoms.

Is a diagnostic laparoscopy billed with the surgical laparoscopy?

No. Surgical laparoscopy includes diagnostic laparoscopy (NCCI chapter VII §F.1). If a diagnostic laparoscopy leads to the decision to do an open procedure, it may be reported, with modifier 58 for staged procedures. A laparoscopy converted to open is reported as the open procedure only.