Gynecology CPT codes range from 56405-58999 and cover a wide variety of procedures related to the female reproductive system. These include evaluation and management services, diagnostic procedures, surgical procedures, and obstetric services.
In OB/GYN practices, accurate billing is the backbone of a healthy revenue cycle. But between complex payer rules, bundled maternity services, and evolving documentation requirements, OBGYN billing and coding can quickly become overwhelming. Each visit, whether it’s a preventive screening, prenatal appointment, delivery, or surgical procedure, requires precise selection of gynecology CPT codes, OBGYN CPT codes, or OB GYN CPT codes.
Even a small error in assigning the correct OBGYN CPT code or applying the right modifier can trigger claim denials, compliance issues, or costly delays in reimbursement. Same for pain management CPT codes. However, to keep payments consistent and operations smooth, OB/GYN providers must follow proven billing and coding guidelines designed specifically for women’s health services.
In this guide, we outline the core components of OB-GYN CPT codes, common challenges, and actionable guidelines for healthcare providers to streamline billing operations and improve revenue cycle outcomes.
The Stakes of OBGYN Coding Errors
According to the Centers for Medicare & Medicaid Services (CMS), 40% of improper payments in outpatient settings stem from documentation and coding errors. In obstetrics and gynecology, this is compounded by global maternity packages, surgical modifiers, and payer-specific bundling rules. A missed modifier or an incorrect revenue code can disrupt payments or trigger audits.
Moreover, data from the American Medical Association (AMA) suggests that practices lose an average of 3%–5% of annual revenue due to recurring coding inaccuracies, an amount that adds up significantly in high-volume OB/GYN clinics.
OB/GYN CPT Codes Cheat Sheet (2025)
Routine Obstetric Care |
| 59400 – Routine antepartum care, vaginal delivery, and postpartum care |
| 59510 – Routine antepartum care, cesarean delivery, and postpartum care |
| 59610 – Routine antepartum care, vaginal delivery after previous cesarean, and postpartum care |
| 59618 – Routine antepartum care, cesarean delivery after attempted vaginal delivery, and postpartum care |
Diagnostic Procedures |
| 57452 – Colposcopy with biopsy |
| 58100 – Endometrial biopsy |
| 76801–76828 – Obstetric ultrasound (first to third trimester) |
| 76830 – Transvaginal ultrasound |
Surgical Procedures |
| 58140 – Myomectomy (removal of uterine fibroids) |
| 58150 – Total abdominal hysterectomy |
| 58570 – Laparoscopic hysterectomy |
| 58700 – Salpingectomy (removal of fallopian tube) |
| 58956 – Oophorectomy (removal of ovary) |
Infertility Treatment |
| 58970 – Oocyte retrieval for in vitro fertilization (IVF) |
| 58974 – Embryo transfer for IVF |
| 58976 – Gamete intrafallopian transfer (GIFT) |
Contraceptive Procedures |
| 58300 – Insertion of intrauterine device (IUD) |
| 58301 – Removal of intrauterine device (IUD) |
| Reproductive Health Procedures |
| 59812 – Dilation and curettage (D&C) for incomplete abortion |
| 59840 – Induced abortion (first trimester) |
Modifiers |
| Modifier 25 – Significant, separately identifiable evaluation and management service by the same physician on the same day |
| Modifier 51 – Multiple procedures |
| Modifier 57 – Decision for surgery |
Commonly Used OBGYN CPT Codes
Accurate coding begins with familiarity. Below are frequently billed OB-GYN CPT codes every provider should be proficient in:
- 99213–99215: Office or outpatient E/M visits
- 59400: Routine obstetric care (antepartum, delivery, postpartum)
- 59510: Cesarean delivery package
- 58100: Endometrial biopsy
- 58300: Insertion of intrauterine device (IUD)
- 57500: Cervical conization
- 76830: Transvaginal ultrasound
Each code must be paired with medical necessity (ICD-10) and, if applicable, modifiers that justify its use within the same encounter. We also do have a list for Chiropractic CPT codes.
Revenue Code Errors in OB/GYN
Misclassifying revenue codes, such as using 0450 (ER services) instead of 0721 (labor/delivery room), remains a significant challenge in OBGYN billing and coding, particularly within facility settings. Recent trends show that approximately 15%–20% of OB/GYN claims are denied due to coding or pairing errors, including revenue code mismatches.
Meanwhile, overall denial rates continue to climb, with initial claim denials rising to 11.8% in 2024. CMS continues to reinforce the proper use of 072x series revenue codes for OB-specific procedures to ensure compliance and avoid potential overpayment recovery.
Understanding Bundled Services in Obstetrics
One of the unique challenges of OB-GYN billing and coding is global maternity care. The AMA’s CPT guidelines define services like 59400 as inclusive of all routine prenatal, delivery, and postpartum care.
Billing individual services within the package (e.g., separate E/M visits or fetal ultrasounds) without supporting documentation may be flagged as unbundling. CMS and major commercial payers advise practices to maintain clear records and only carve out services that are truly outside the scope of global billing.
Best Practices for Accurate OBGYN Billing
- Track Global Billing Periods: Automated billing systems should flag claims falling within global periods. The Office of Inspector General (OIG) recommends technology-enabled tracking to avoid duplicate or erroneous claims.
- Ensure ICD-10/CPT Consistency: A mismatch between the OB-GYN CPT code and the diagnosis code is a primary denial reason. For instance, 58300 must align with ICD-10 codes such as Z30.430 (encounter for IUD insertion) or N92.0 (excessive menstruation).
- Use Modifiers with Caution: A 2022 payer audit published by Aetna revealed that modifier -25 was misused in 30% of OB claims, often applied to non-separately identifiable E/M services. This reinforces the need to justify modifiers with robust documentation.
- Conduct Routine Internal Audits: Per AMA best practices, quarterly coding audits help practices catch discrepancies early, train staff, and avoid payer clawbacks.
Compliance Considerations in OB/GYN Billing
Compliance extends beyond reimbursement. It encompasses documentation, privacy, and adherence to payer policies.
- Medical Necessity: All services must be supported by documented clinical need. According to CMS, “lack of medical necessity” was the second most common reason for claim denials in OB/GYN procedures in 2023.
- HIPAA Security Rule: Sensitive reproductive health data must be securely handled during billing. Practices are advised to encrypt billing communications and avoid disclosing unnecessary details on claims.
- Modifier and Code Justification: Auditors often look for patterns in modifier use. For example, frequent use of -59 without a documented rationale may indicate unbundling abuse.
What Existing Blogs Missed, and Why It Matters
While top resources like MedibillMD and ACOG provide valuable code lists and structural overviews, they lack insights into billing operations and payer-specific compliance realities. Here’s what was missing:
- Facility Billing Knowledge: None of the blogs provided guidance on revenue code alignment, which is critical for hospital-affiliated OB/GYNs.
- Payer Variation Awareness: Policies around postpartum care reimbursement or bundled services vary by payer; Blue Cross differs significantly from UnitedHealthcare in this regard.
- Coding Performance Data: There’s a lack of industry-wide denial rate benchmarks or CPT-specific error statistics, which are essential for operational improvement.
- Training and Staff Support: Billing staff often struggle with updates from the AMA or payer bulletins. Blogs rarely address ongoing education strategies.
AffinityCore fills these gaps by offering not just coding expertise, but a full-spectrum approach to OB-GYN billing and coding, from compliance training to EHR optimization.
What Makes AffinityCore the Best Choice for OBGYN Revenue Cycle Support
At AffinityCore, we help women’s health practices eliminate revenue leakage, reduce claim denials, and stay compliant with every update from AMA, CMS, and major insurers. Our specialized teams stay current on evolving OB-GYN CPT codes, modifiers, revenue codes, and outsource medical billing services, so your team doesn’t have to.
We combine deep expertise with AI-enhanced auditing tools to proactively identify problems before they become denials. Whether you’re a small private clinic or a hospital-based OB/GYN group, our team is equipped to elevate your revenue cycle outcomes.
Final Thoughts
Effective OB-GYN billing and coding isn’t about memorizing CPT codes; it’s about applying them in context, aligning them with payer expectations, and documenting every service with clarity and compliance in mind.
With the right tools, training, and partners, healthcare providers can reduce administrative burdens and maximize revenue, all while maintaining focus on patient care.
