OB/GYN practices across Maryland face growing pressure to manage a complex mix of services, from routine wellness exams and ultrasounds to high-risk pregnancy monitoring and surgical procedures. Amidst this, accurate and efficient billing is critical—not only for maintaining cash flow but also for staying compliant with evolving payer policies.
At Global Tech Billing LLC, we specialize in OB/GYN medical billing for Maryland providers. Our team helps OB/GYN clinics get paid faster, reduce denials, and optimize every claim—whether it’s for a routine Pap smear or a detailed obstetric ultrasound. In this guide, we cover the most important CPT codes, billing tips, and payer quirks every OB/GYN practice in Maryland should know.
Why OB/GYN Billing Requires Specialized Expertise
OB/GYN is a multifaceted specialty. Providers bill for a wide range of services that include:
- Annual well-woman exams
- Diagnostic and transvaginal ultrasounds
- Pap smears and HPV testing
- Prenatal care and deliveries
- Colposcopies, biopsies, and LEEP procedures
- IUD insertion/removal and contraceptive counseling
Each of these services has unique coding and documentation requirements. Missteps can lead to denied claims, delayed payments, or undercoding that results in lost revenue. Cardiology billing includes high-complexity CPT codes and time-based services. Boost accuracy with these essential tips forcardiologist medical billing.
CPT Codes Every OB/GYN Provider in Maryland Should Know
Well-Woman Exams & Preventive Services
- 99384–99387 – Initial comprehensive preventive visit (new patient, based on age)
- 99394–99397 – Periodic preventive exam (established patient)
- Q0091 – Screening Pap smear collection (Medicare)
- G0101 – Pelvic and breast exam (Medicare)
Tip: Many commercial payers bundle Q0091 and G0101 with preventive visits, while others reimburse separately. Be sure to verify the payer’s policy before billing.
Ultrasound Billing
Ultrasounds are core to OB/GYN practice but frequently denied due to documentation or frequency limits.
- 76801 – OB ultrasound, 1st trimester, complete
- 76805 – OB ultrasound, 2nd or 3rd trimester, complete
- 76811 – High-risk OB ultrasound with detailed anatomic exam
- 76830 – Transvaginal ultrasound (non-obstetric)
- 76856 – Pelvic ultrasound (non-obstetric)
Best Practice: Always document the medical necessity, gestational age, and clinical indication for each ultrasound. For OB ultrasounds, include LMP and EDC in the report to support frequency and timing.
Pap Smears & HPV Testing
While a Pap smear itself doesn’t have a CPT code (it’s typically included in a preventive visit), associated services include:
- 88142–88175 – Cytopathology for Pap smears
- 87624 – HPV testing using DNA
- G0476 – HPV testing (Medicare)
Documentation Reminder: Always link these services to appropriate Z-code diagnoses (e.g., Z12.4 for cervical cancer screening) or problem-based ICD-10 codes if done diagnostically.
Internal medicine billing often involves a broad code range. For better accuracy and collections, review this guide on internal medicine billing.
Top Billing Mistakes OB/GYNs Make in Maryland
At Global Tech Billing LLC, we’ve audited hundreds of OB/GYN claims. Here are the most common mistakes we see—and how to fix them.
1. Missing Global OB Package Documentation
Many providers underbill for prenatal care by omitting global maternity packages.
- 59400 – Routine obstetric care with vaginal delivery
- 59510 – Routine OB care with cesarean delivery
To bill these properly, your documentation must cover 13+ prenatal visits, delivery, and postpartum care. If the patient transfers care or doesn’t complete all visits, bill individual E/M codes instead.
2. Incorrect Use of Modifiers
Modifiers are vital in OB/GYN billing, especially when providing multiple services during a single visit.
- Modifier 25 – Use when a significant, separately identifiable E/M service is performed on the same day as a procedure (e.g., pelvic exam + IUD insertion)
- Modifier 59 – Distinguishes distinct procedures (e.g., Pap smear + biopsy)
- Modifier 26/TC – Applies to imaging studies when billing for professional or technical components separately
Billing Tip: In Maryland, CareFirst and UnitedHealthcare are strict on modifier use. Claims without appropriate modifiers are often denied.
3. Frequency Limitations on Preventive Services
Many payers allow one preventive visit per calendar year, not 12 months. Billing too soon—even by a few days—can lead to denials.
Solution: Verify the last service date through the insurer’s portal before scheduling the next annual visit.
Pediatric billing comes with age-specific modifiers and visit types. Make sure you’re coding correctly with this resource on pediatric medical billing.
4. Missed Revenue for In-Office Procedures
Procedures like colposcopy, LEEP, and IUD insertions are high-reimbursement services, but often underbilled due to lack of supporting documentation or incorrect code pairing.
Examples:
- 57454 – Colposcopy with biopsy and endocervical curettage
- 57522 – LEEP procedure
- 58300 – IUD insertion
- 58301 – IUD removal
Ensure documentation includes:
- Reason for procedure
- Informed consent
- Technique used
- Follow-up plan
Real-World Example: Maryland OB/GYN Revenue Turnaround
A mid-sized OB/GYN clinic in Anne Arundel County contacted Global Tech Billing LLC due to a 30% denial rate on their ultrasound claims. After a full audit, we found:
- Missing modifiers on transvaginal ultrasounds
- No documentation of gestational age
- Incorrect pairing of 76830 with problem-based ICD-10 codes
Within 45 days, we corrected claim issues, trained staff on coding accuracy, and reduced their denial rate by over 80%, resulting in an increase of $18,000 in monthly collections.
How We Help OB/GYN Providers in Maryland Thrive
At Global Tech Billing LLC, our OB/GYN billing services are tailored to meet the specific needs of Maryland practices. We offer:
- Expert CPT and ICD-10 coding support
- Accurate claim submission with modifier logic
- Pre-authorization support for high-risk OB imaging
- Monthly reporting and A/R tracking
- Denial prevention and rapid appeals
With our team, providers get peace of mind—and better collections.
Conclusion: Let Your Care Shine—We’ll Handle the Billing
As an OB/GYN, your focus should be on patient care, not chasing claims. With increasingly strict payer rules, it’s more important than ever to have a billing partner who understands your specialty—and your local market.
Global Tech Billing LLC helps Maryland OB/GYN providers reduce administrative overhead, improve claim accuracy, and increase practice revenue. Whether you’re dealing with bundled visits, procedure denials, or OB package confusion—we’ve got your back.
FAQs
1. Can I bill a preventive exam and a problem visit on the same day?
Yes, but only if both services are separately documented. Use Modifier 25 on the problem-focused E/M code.
2. Do I need to bill for Pap smear collection separately?
Only for Medicare and some specific commercial plans. Use Q0091 if the plan reimburses separately.
3. Why do my OB ultrasounds keep getting denied?
Common reasons include missing documentation (LMP, EDC), incorrect ICD-10 codes, or lack of medical necessity. We can audit and correct this.
4. What happens if a patient switches OB providers mid-pregnancy?
If less than 13 visits were performed, bill individual E/M visits instead of the global OB package.
5. How can Global Tech Billing LLC help my OB/GYN clinic specifically?
We provide OB/GYN-specialized billing support tailored to Maryland rules, from preventive coding to complex prenatal care—and we fight to get every dollar you deserve.
