OB/GYN coding requires precision across prenatal, delivery, postpartum, and gynecological encounters. Global obstetric packages, trimester-specific codes, and procedure-level CPT detail are all critical to accurate billing. This page covers the top ICD-10-CM and CPT codes used by OB/GYN practices across the United States.
FY 2026 ICD-10-CM (CMS) · CPT codes updated annually · All codes verified billable · Last verified: June 2026
Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
~$2,340
-54, -55, -62
59510
Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
~$2,690
-54, -55, -62
76805
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester
~$107
-26, -TC
58100
Endometrial sampling (biopsy) with or without endocervical sampling, without cervical dilation
~$118
-25, -59
57455
Colposcopy of the cervix including upper/adjacent vagina with biopsy(s) of the cervix
~$194
-25, -59
99213
Office or other outpatient visit, established patient, low medical decision making complexity
~$92
-25, -95, -GT
99214
Office or other outpatient visit, established patient, moderate medical decision making complexity
~$130
-25, -95, -GT
57170
Diaphragm or cervical cap fitting with instructions
~$74
-25
58300
Insertion of intrauterine device (IUD)
~$105
-25, -59
58301
Removal of intrauterine device (IUD)
~$94
-25, -59
58661
Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
N/A (facility only)
-50, -51, -62, -80
58120
Dilation and curettage, diagnostic and/or therapeutic (nonobstetric)
N/A (facility only)
-58, -78, -79
76817
Ultrasound, pregnant uterus, real time with image documentation, transvaginal
~$78
-26, -TC
57500
Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration
~$138
-25, -59
59025
Fetal non-stress test
~$68
-26, -TC
81025
Urine pregnancy test, by visual color comparison methods
~$6
-QW
88141
Cytopathology, cervical or vaginal; requiring interpretation by physician
~$27
-26
*Approximate 2025 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.
Top Denial Reasons for OB/GYN Claims
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Missing or Incorrect Diagnosis-Procedure Linkage
Payers deny OB/GYN claims when the ICD-10 diagnosis code does not clinically support the billed CPT procedure (e.g., billing a colposcopy with only a well-woman visit diagnosis). Always link procedure codes to a specific, supporting diagnosis and document medical necessity explicitly in the encounter note.
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Global Obstetric Package Unbundling
Billing individual antepartum visits (99213/99214) during a global OB episode (59400/59510) without proper modifier -52 or -54/-55 split-care documentation results in automatic denials. Ensure the global package is correctly assigned or use appropriate modifiers when care is divided between providers.
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Prior Authorization Not Obtained for Procedures
Many payers require prior authorization for laparoscopic surgeries, hysteroscopy, and advanced imaging (e.g., 76805, 58661) especially under managed care plans. Verify authorization requirements before scheduling elective gynecologic procedures and attach the auth number in Box 23 of the claim form.
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Modifier -25 Missing on Same-Day E/M and Procedure
When a significant, separately identifiable E/M service (99213/99214) is performed on the same day as a minor procedure (IUD insertion, endometrial biopsy, colposcopy), modifier -25 must be appended to the E/M code. Without it, payers bundle the office visit into the procedure fee and deny the E/M as included.
OB/GYN Billing & Coding Tips
Obstetric codes from Chapter 15 (O00–O9A) require a 7th character for the trimester (1, 2, 3) or delivery (4).
Global obstetric package CPT codes (59400, 59510) include all antepartum, delivery, and postpartum services — do not separately bill individual visits included in the global.
Code fetal conditions using Z3A.xx codes (weeks of gestation) as an additional code to all Chapter 15 codes.
Pap smear/cervical cytology (Q0091 or 88141–88175) is a preventive service and may have different patient cost-sharing rules than diagnostic services.
What is the ICD-10 code for a normal prenatal visit?
Z34.00 is used for supervision of a normal first pregnancy in an unspecified trimester. Add Z3A.xx (weeks of gestation) as an additional code. For subsequent pregnancies, use Z34.30–Z34.39.
What does the global OB package include?
CPT 59400 (vaginal) and 59510 (cesarean) global packages include all antepartum visits from 4 weeks to delivery, the delivery, and the postpartum visit. Individual E&M visits during this period should not be billed separately to the same payer unless complications arise.
What ICD-10 code is used for menopause?
N95.1 covers menopausal and female climacteric states, including hot flashes, insomnia, and mood changes related to menopause. Z78.0 (Asymptomatic menopausal state) is used when there are no symptoms.
When is 57455 (colposcopy with biopsy) billed?
57455 is billed when the physician performs a colposcopy and takes a cervical biopsy during the same session. If no biopsy is taken, use 57420 (colposcopy without biopsy). Separate codes exist for ECC (57456) and LEEP (57461).
How does OmniMD support OB/GYN practices?
OmniMD’s OB/GYN EHR provides trimester-aware documentation templates, global OB package tracking, and integrated e-prescribing for prenatal vitamins and obstetric medications with cross-check for contraindicated drugs.
Streamline Your OB/GYN Practice with OmniMD
Purpose-built EHR, billing, and practice management for OB/GYN practices.
