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Thread: Medicare OB billing

  1. #1

    Default Medicare OB billing

    AAPC: Back to School
    Does anyone have a suggestion where I can find guidelines for OB Medicare billing?

  2. #2
    Join Date
    Apr 2007


    I have the same question!
    Do we bill each visit or should we bill globally?
    We have emailed a Medicare rep over and over again and do not get a response! Please help!!

  3. #3
    Join Date
    Apr 2007


    The AMA has coding books for specialty coding including OB guidelines, they are in our members catalog in AAPC. OB codes such as 59400 include the antepartum, delivery, and postpartum. There are other services that are billable during the gestation but they must be documented medically necessary, or high risk pregnancy procedures, such as additional ultrasounds, other fetal monitoring, etc. If a patient is seen for services other than pregnancy then that would need to be coded as such with the appropriate dx and possible modifier. Another good resource is the AAFP, American Academy of Family Physicians, very helpful.

    For Medicare guidelines I would suggest reviewing any NCD/LCDs on this (IF ANY). Medicare generally denies routine exams. It would be interesting to know what you find out from them. Or did you mean Medicaid or MediCal? They do cover up to 8 weeks during postpartum, including IUD insertions, and eligible sterilizations along with consent forms. You bill the global cpt 59400, 59510, or 59610 on date of delivery.
    Last edited by shaanah; 09-14-2008 at 05:01 AM. Reason: add info

  4. #4


    I did mean Medicare - this patient is on disability Medicare.......thanks for the thoughts...

  5. #5

    Default Non-Covered

    Pregnancy is a non-covered service for Medicare patients. Most patients are able to get Medicaid for Pregnant Women in order to cover their pregnancy-related services.
    Hope this helps...although it is WAY late.

  6. #6
    Join Date
    Apr 2007

    Default Medicare OB Billing

    Been there! Medicare does not allow for OB services therefore, we have always billed them to Medicare with a GZ modifier as a not normally covered service under the Medicare program. Use your coding rules and apply the Medicare GZ modifier as it is not a Medicare benefit.

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