What Are the Most Important OBGYN CPT Codes

OBGYN billing is one of the hardest parts of running a practice. Nearly one-fifth of claims are denied, largely due to coding errors. Every OBGYN CPT code must be accurate. Even a small mistake can delay payment or cause a denial. This not only slows cash flow but also adds stress for providers and staff. Instead of focusing on patients, many practices end up chasing claims. That is why knowing OBGYN billing codes is more than office work. It is the key to steady revenue and peace of mind.

What are the Most Common CPT & ICD-10 Codes for OB/GYN Billing?

In OB/GYN billing, every claim needs to answer two simple questions: What was done? And why was it done? CPT codes explain the “what,” while ICD-10 codes explain the “why.” When both parts match the chart, payers see a clear story and pay on time.

Top CPT Codes in Obstetrics

Here is a quick guide to the most-used CPT codes for obstetrics. Pair with the correct ICD-10 diagnosis and follow payer rules for the maternity package.

CPT code	Short name	Typical use	Key notes
59400	Routine OB care; vaginal, global	Complete maternity care with vaginal delivery	Global package (antepartum + delivery + postpartum)
59510	Routine OB care; cesarean, global	Complete maternity care with C-section delivery	Global package
59610	Routine OB care; VBAC vaginal, global	Complete care when the patient delivers vaginally after a prior C-section	Global package
59618	Routine OB care; failed VBAC → C-section, global	Complete care when the trial of labor after C-section ends in C-section	Global package
59425	Antepartum care only (4–6 visits)	Prenatal care when not billing global	Count visits; not global
59426	Antepartum care only (7+ visits)	Prenatal care when not billing global	Count visits; not global
59430	Postpartum care only	Postpartum visit when delivery was elsewhere or not in global	Not global
59409	Vaginal delivery only	Delivery only	Delivery only
59514	Cesarean delivery only	Delivery only	Delivery only
59612	VBAC vaginal delivery only	Delivery only	Delivery only
59620	C-section after attempted VBAC, delivery only	Trial of labor after C-section that ends in C-section	Delivery only
59412	External cephalic version	Turning the fetus to head-down	Often separate from global; document time, success, and support
59025	Fetal non-stress test (NST)	Antenatal testing	Usually per session; may repeat
59000	Amniocentesis, diagnostic	Sampling amniotic fluid	Check imaging guidance policy and lab billing
76801	OB ultrasound, first trimester, complete	Dating/viability <14 weeks	Use 26/TC when applicable
76805	OB ultrasound, 2nd/3rd trimester, complete	Anatomy/growth ≥14 weeks	Document required views
76811	Detailed fetal anatomy ultrasound	High-detail scan for anomalies	Higher bar for required elements
76815	Limited OB ultrasound	Focused check	Not for full anatomy
76816	Follow-up OB ultrasound	Reevaluation of a known issue	Requires prior study
76817	Transvaginal OB ultrasound	Early pregnancy or cervix/placenta views	Use when medically needed
76818	Biophysical profile (with NST)	Fetal well-being	Document components
76819	Biophysical profile (without NST)	Fetal well-being	Document components
76820	Fetal Doppler, umbilical artery	Doppler velocimetry	Growth restriction
76821	Fetal Doppler, MCA	Doppler of the middle cerebral artery	For anemia risk

Top CPT Codes in Gynecology

Here is a clear, working list of the OBGYN CPT codes you’ll use most in gynecology.

CPT code	Short name	Typical use	Key notes
99202–99205	New patient E/M	Problem-focused new visit	Code by MDM or time per 2021+ rules
99212–99215	Established patient E/M	Problem-focused follow-up	Code by MDM or time
99384–99387, 99394–99397	Preventive (age-based)	Well-woman preventive visit	Use modifier 25 only if a significant problem E/M is added
58300	IUD insertion	LARC placement	Bill the device with HCPCS
58301	IUD removal	LARC removal	Removal + reinsertion may both be reported
57500	Cervical biopsy / local excision	Cervical biopsy or polyp removal	Without colposcopy
57505	Endocervical curettage (ECC)	ECC without D&C	Not reported with D&C
57454	Colposcopy + biopsy and ECC	Abnormal Pap/HPV	Choose by the components done
57455	Colposcopy + cervical biopsy(s)	Colposcopy with biopsy only	—
57456	Colposcopy + ECC	Colposcopy with ECC only	—
57460	Colposcopy + loop electrode biopsy	LEEP-type biopsy	Do not confuse with conization
57461	Colposcopy + loop electrode conization	LEEP cone	Excisional cone
57520	Cold-knife/laser conization	Excisional cone	May include D&C/repair
57522	LEEP conization (no colposcope)	Loop cone excision	—
58555	Hysteroscopy, diagnostic	Visualize the uterine cavity	Bundled into a surgical scope
58558	Hysteroscopy with endometrial sampling and/or polypectomy ± D&C	Hysteroscopic biopsy or polyp removal	Document elements
58561	Hysteroscopic myomectomy	Remove submucous fibroids	Check policy
58563	Hysteroscopic endometrial ablation	Treat AUB via ablation	Device-specific rules
58100	Endometrial biopsy (office)	Sample endometrium	If dilation needed, use 58120
58110	Endometrial biopsy with colposcopy (add-on)	With colposcopy	Use instead of 58100
58120	Dilation & curettage (non-obstetric)	Therapeutic/diagnostic	Not postpartum curettage
58660	Laparoscopy with lysis of adhesions	Salpingo/ovariolysis	“Separate procedure” only if independent
58661	Laparoscopic salpingo-oophorectomy	Tube/ovary removal	Match to diagnosis
58662	Laparoscopic excision/fulguration	Endometriosis/lesions	—
58570–58573	Total laparoscopic hysterectomy	TLH by uterus weight/adnexa	Pick code by size/extent
56501 / 56515	Destruction of vulvar lesions	VIN, warts	Simple vs. extensive
57420 / 57421	Vaginal colposcopy (± biopsy)	Vaginal evaluation	Different from cervical colposcopy
56820 / 56821	Vulvar colposcopy (± biopsy)	Vulvar evaluation	Report separately if distinct

Note: IUD device supply uses HCPCS (not CPT). Pap collection may use HCPCS Q0091 under some payers. The lab’s cytology is billed separately.

ICD-10-CM You Must Get Right in Obstetrics

In obstetrics, ICD-10-CM must match the service you billed with OBGYN CPT codes. Use pregnancy-specific codes first, add the trimester and weeks, and point to the exact fetus when there are multiples. Then link each diagnosis to the correct CPT service (the CPT codes for OBGYN you selected).

Code family	What it covers	Use when…	Document / Pair with
Z34.-	Supervision of normal pregnancy by trimester	Routine prenatal care with no complications	Note trimester and parity; pair with routine prenatal services inside the global package
O09.-	Supervision of high-risk pregnancy	Advanced maternal age, prior preterm birth, poor obstetric history, or other risk	State the risk reason and trimester; link to high-risk visits or extra testing
Z3A.xx	Weeks of gestation	You need to state exact weeks (e.g., 28 weeks)	Add to most pregnancy encounters; supports frequency edits and medical necessity
O00.-	Ectopic pregnancy	Pregnancy is outside the uterus (e.g., tubal)	Include site and complications; pair with treatment or surgical CPT
O02.-	Other abnormal products of conception	Missed abortion, blighted ovum	Use when pregnancy is nonviable without expulsion; support with imaging/labs
O03.-	Spontaneous abortion	Miscarriage with or without complications	Specify complete vs. incomplete when known; pair with management or D&C if performed
O20.-	Hemorrhage in early pregnancy	Threatened abortion or first-trimester bleeding	Include amount, stability, and ultrasound findings
O21.-	Hyperemesis gravidarum	Severe nausea/vomiting, with or without dehydration	Document weight loss, ketones, hydration, and treatments
O23.-	Infections in pregnancy (GU tract)	UTI, pyelonephritis, vaginitis during pregnancy	Note organism if known; link to antibiotics and follow-up
O24.-	Diabetes in pregnancy	Preexisting type 1 or type 2, or gestational diabetes	State type and control (diet/insulin/meds); link to NSTs, ultrasounds, or education as needed
O10–O16	Hypertensive disorders	Chronic HTN, gestational HTN, preeclampsia, eclampsia	Capture type and severity; pair with monitoring, labs, or delivery decisions
O26.-	Other pregnancy-related conditions	Conditions due to pregnancy not elsewhere classified	Use precisely; avoid when a more specific O code exists
O30.-	Multiple gestation	Twins or higher order	Add fetus-specific 7th character when required; include chorionicity if documented
O32.-	Maternal care for malpresentation	Breech, transverse, oblique	Add fetus number for multiples; pair with ECV or delivery planning
O33.-	Maternal care for disproportion	Cephalopelvic disproportion or suspected macrosomia	Use when it guides delivery planning
O34.-	Maternal care for pelvic/uterine abnormalities	Uterine scar, fibroids, cervical insufficiency	Include device/procedure if placed (e.g., cerclage)
O35.-	Maternal care for fetal abnormalities	Known or suspected fetal anomaly	Include specific anomaly if known; add fetus number as required
O36.-	Maternal care for other fetal problems	Fetal growth restriction, demise, isoimmunization	Add fetus number; pair with growth scans, Dopplers, or NST/BPP
O40.-	Polyhydramnios	Excess amniotic fluid	Document severity and management
O41.-	Amniotic fluid/membrane disorders	Oligohydramnios, infection of membranes	Specify condition; link to ultrasound or antibiotics
O42.-	Premature rupture of membranes (PROM/PPROM)	Rupture before labor or preterm	Include timing and complications; pair with steroids, antibiotics, or delivery
O44.-	Placenta previa	Placenta covering or near the os	Specify type and bleeding; guides delivery route
O45.-	Placental abruption	Suspected or confirmed abruption	Document severity and fetal/maternal status
O47.-	False labor	Contractions without cervical change	Use when ruled-out labor explains the visit
O48.-	Prolonged pregnancy	≥ 42 weeks	Use with Z3A weeks and delivery planning
O99.-	Other maternal diseases complicating pregnancy	Anemia, endocrine/thyroid disease, obesity, tobacco or drug use, mental disorders	Combine with underlying condition codes when required; show impact on care
Z37.-	Outcome of delivery	Delivery has occurred	Add when required by setting/payer policy
Z39.-	Postpartum care and exam	Routine postpartum follow-up	Use for standard postpartum encounters without complications

ICD-10-CM You Must Get Right in Gynecology

In gynecology, the right diagnosis code must support the service you bill with OBGYN CPT codes (the CPT codes for OBGYN procedures and visits). Use the most specific OBGYN ICD 10 codes your note supports, and link each one to the exact CPT line.

ICD-10-CM family	What it covers	Use when…	Document / Pair with (CPT examples)
N80.-	Endometriosis	Laparoscopy or imaging confirms/strongly suggests endometriosis	Site and laterality; pair with laparoscopy, lesion excision/ablation, pain management
D25.-	Uterine fibroids (leiomyoma)	Fibroids drive AUB, pain, pressure, and infertility	Size, number, symptoms; pair with ultrasound, hysteroscopy, myomectomy, hysterectomy
N84.-	Polyps (cervix/uterus/vagina)	Polyp found on exam or imaging	Location and symptoms; pair with polypectomy (office or hysteroscopic)
N92.-	Heavy/frequent/irregular menses	Cycles are heavy or too frequent (AUB)	Pattern, duration, clots, anemia; pair with E/M, labs, ultrasound
N93.-	Other AUB (intermenstrual, postcoital)	Bleeding outside the normal pattern	Trigger, timing, pregnancy ruled out; pair with EMB, hysteroscopy, ultrasound
N94.-	Dysmenorrhea, pelvic pain, dyspareunia	Menstrual or pelvic pain impacts function	Onset, severity, red flags; pair with E/M, imaging, laparoscopy if indicated
N83.-	Ovarian/adnexal disorders (cysts, torsion)	Cyst, torsion, or other adnexal issue	Side, size, complexity; pair with ultrasound, cystectomy, oophorectomy as needed
N70.-	Salpingitis/oophoritis (PID)	Clinical PID or related infection	Exam/lab support; pair with antibiotics, follow-up testing
N72	Cervicitis/endocervicitis	Inflammation or infection of the cervix	Organism if known; pair with testing and treatment
N76.-	Vaginitis/vulvovaginitis	BV, Candida, trichomonas, nonspecific	Organism or “unspecified” if truly unknown; pair with testing/therapy
A63.0	Anogenital warts (HPV)	Visible condyloma	Site and extent; pair with destruction or excision
N87.-	Cervical dysplasia (CIN I–III)	Abnormal histology after colpo/biopsy	Grade and margins; pair with colposcopy, LEEP, or CKC as indicated
D06.-	Carcinoma in situ of the cervix (CIS)	CIS confirmed on pathology	Histology and margin status; pair with conization/LEEP
R87.-	Abnormal cervical/vaginal cytology	ASC-US, LSIL, HSIL, atypical glandular, HPV positive	Exact cytology result; pair with colposcopy/biopsy and follow-up
N88.-	Noninflammatory cervical disorders	Stenosis, ectropion, and old laceration	Symptoms and impact; pair with dilation/repair when needed
N89.- / N90.-	Vaginal/vulvar disorders	Atrophy, lesions, pain, dermatoses	Site and severity; pair with biopsy, medical therapy
N39.0	UTI, site not specified	Dysuria, positive UA/culture	Culture if available; pair with antibiotics
N39.3 / N39.41	Stress/urge incontinence	Stress leakage or urge/OAB symptoms	Stress tests, bladder diary; pair with urodynamics, pelvic floor therapy
N32.81	Overactive bladder	Urgency, frequency, nocturia with/without urge incontinence	Failed conservative steps; pair with meds, PTNS/Botox if applicable
Z01.411 / Z01.419	Gyn exam with/without abnormal findings	Routine well-woman visit	Findings and counseling; pair with preventive E/M
Z12.4	Cervical cancer screening	Pap/HPV screening encounter	Screening intent; pair with collection and lab codes per payer
Z11.3 / Z11.51	STI or HPV screening	Asymptomatic screening visit	Risk factors if relevant; pair with appropriate tests
Z30.-	Contraceptive management	Counseling, IUD/implant, pill/Rx follow-up	Method chosen, risks/benefits; pair with IUD insertion/removal and device HCPCS

Common Modifiers And Their Rules You Must Follow

Modifiers add detail to your OBGYN CPT code. They do not change the service. They explain how, why, or when you did it. In OB/GYN, the right modifier keeps your OBGYN billing codes clean. It also shows how your OBGYN CPT codes line up with your OBGYN ICD 10 codes. Used well, modifiers cut denials. Used wrong, they trigger edits.

Below is a focused, OB/GYN-ready guide. Each rule is short and practical. Apply it the same way every time.

High-impact modifiers you’ll use most

Modifier	Use it when…	Do not use when…	Documentation keys
25	Separate, significant E/M on the same day as a minor procedure (e.g., problem visit + IUD insertion).	The visit was only for the procedure/consent.	Show distinct problem, full Hx/Exam/MDM or time, and link to correct diagnosis.
57	E/M was the decision for major surgery (90-day global), same/previous day.	The surgery is minor (0–10-day global).	State that the E/M led directly to surgery, with risks/options noted.
24	Unrelated E/M during a post-op global.	Visit is related to surgery or routine follow-up.	Use a different diagnosis; explain why unrelated.
58	Planned/staged or more extensive related procedure in the global period.	Return to OR was unplanned due to complications.	Document staging plan or medical need.
78	Unplanned return to OR for related procedure during global (e.g., hemorrhage).	The procedure was planned or unrelated.	Note complication + OR return.
79	Unrelated procedure during the global period.	The procedure is related to the original surgery.	Use different diagnoses and explain the unrelated nature.
51	Multiple procedures in one session (rank by RVU; add modifier to 2nd+).	Payer requires 59/X-modifiers instead.	List each procedure distinctly; follow payer hierarchy.
59	Distinct procedural service (separate site, lesion, session, organ).	A more specific XE/XS/XP/XU modifier is required.	Show why distinct (e.g., different lesion/site).
XE	Separate encounter (Medicare subset of 59).	Service was the same encounter.	Document the timing of a separate encounter.
XS	Separate structure.	Same structure involved.	Specify the exact anatomic site.
XP	Separate practitioner.	The same physician performed both.	Note provider differences.
XU	Unusual non-overlap of services.	Standard overlap/bundle.	Explain the unusual circumstance.
26	Professional component only (interpretation/report of imaging).	You also supplied equipment (global).	Signed report required.
TC	Technical component only (equipment, images).	Only interpreted study.	Saved images + tech logs.
50	Bilateral procedure done in one session.	Code descriptor is inherently bilateral, or the payer prefers LT/RT.	Document both sides treated.
LT / RT	Unilateral procedure on the left/right side.	Code is bilateral by definition, or the 50 modifier has already been applied.	Identify the side clearly in the note.
22	Unusual/extensive service with far more work.	Work only slightly harder than typical.	Detail complexity, time, risk; attach records if needed.
52	Service reduced by choice (partial service completed).	Stopped early for safety (use 53).	State what portion is done and why it was reduced.
53	Procedure discontinued after starting, for patient safety.	You simply reduced planned service (use 52).	Document when/why stopped + what completed.
76	Repeat the procedure on the same day/session by the same physician.	A different physician repeated it (use 77).	Explain the reason for the repeat (e.g., inadequate sample).
77	Repeat the procedure the same day by a different physician.	The same physician repeated it (use 76).	Identify both providers + reason.
54	Surgical care only.	You provided full global.	State that you only did the surgery.
55	Post-op care only.	You provided full global.	Document post-op care only.
56	Pre-op care only.	You provided full global.	Document pre-op care only.
33	Preventive service, no cost-share (payer-specific).	Service was diagnostic/problem-driven.	Note preventive intent + age appropriateness.
95	Synchronous telemedicine via real-time audio-video.	Asynchronous or audio-only (unless payer allows).	Document technology used, consent, time/MDM.

Recent Updates in OB/GYN Billing 2025

In 2025, OB/GYN billing has seen several important changes. The biggest shift is in telehealth coding. The old telephone E/M codes 99441–99443 have been deleted, and new codes 98000–98016 now cover both audio-video and audio-only visits. Digital assessment codes 98970–98972 also received wording updates to make their use clearer.

Medicare payments have been impacted as well. The conversion factor was reduced from $33.29 to $32.35, resulting in a 2.93% cut in reimbursement for most OB/GYN services. At the same time, the Hospital Outpatient Prospective Payment System (OPPS) introduced new codes for vaccines such as COVID-19, RSV, and influenza, added 23 new proprietary lab analysis (PLA) codes, and removed HCPCS code M0248. Codes 98980 and 98981 also had their payment status changed retroactively.

For procedural coding, new OBGYN CPT codes were introduced for intra-abdominal tumor and cyst excision or destruction, helping providers report these procedures more accurately.Given these changes, practices are being encouraged to strengthen their workflows. Denial prevention now depends heavily on real-time eligibility checks, claim scrubbing, accurate use of global periods, and automation to reduce human error.

Challenges in OB/GYN Billing and Their Quick Fixes

OB/GYN billing comes with unique challenges that often lead to lost revenue if not managed properly. Here are the most common problems providers face and the solutions that work.

Problem: 

OB/GYN billing often bundles prenatal, delivery, and postpartum care into one global package. Many practices mistakenly bill separately for ultrasounds, additional visits, or postpartum complications. Payers frequently deny these claims, causing lost revenue.

Solution: Staff must understand exactly what’s included in the global period and what can be billed separately. For example, complications that require surgical treatment or services unrelated to pregnancy can be billed outside the package with proper documentation. Using modifiers (e.g., 24, 25, 59) correctly helps ensure reimbursement.

Problem: 

Modifiers such as 25 (significant, separately identifiable E/M service) and 59 (distinct procedural service) are commonly misused in OB/GYN claims. Incorrect use either leads to denials or triggers payer audits, both of which slow down cash flow.

Solution: Provide coder training and use billing software that prompts when a modifier is needed. For example, an annual well-woman exam and a problem-oriented visit on the same day require modifier 25 to be paid correctly.

Problem: 

Providers often under-document conditions like high-risk pregnancies, multiple gestations, or complications during delivery. Without this detail, coders cannot apply the correct OBGYN CPT or ICD-10 codes, leading to underpayment.

Solution: Educate providers to link every clinical note to coding needs. Templates within the EHR and real-time coding prompts reduce missed details. For example, documenting “gestational diabetes, diet controlled” instead of just “gestational diabetes” ensures correct risk adjustment and reimbursement.

Problem: 

Each year brings new codes, deletions, and guideline changes. OB/GYN is especially impacted by changes in pregnancy complication codes, gynecological surgery codes, and telehealth E/M rules. Missing updates leads to claim rejections.

Solution: Subscribe to ACOG coding updates and AMA CPT bulletins, and ensure coders attend regular training. Many practices also outsource to billing companies that monitor regulatory changes and update claim scrubbing rules immediately.

Problem: 

Surgeries such as hysterectomies, infertility treatments, or certain imaging tests often require prior authorization. If not handled properly, procedures get delayed, or claims are denied after services are rendered.

Solution: Automate eligibility and authorization checks before scheduling procedures. Dedicated staff or outsourced billing partners can track approvals, preventing unnecessary delays and denials.

Problem: 

Every payer has different rules for OB packages, prenatal visits, and gynecological procedures. What one insurer bundles, another may reimburse separately. This inconsistency leads to billing errors and lost revenue.

Solution: Maintain payer-specific billing guidelines and update them regularly. Using a rules engine within billing software ensures claims are tailored to each insurer’s requirements.

Quick OB/GYN Billing Checklist for Providers

Here’s a quick checklist OB/GYN providers can use to keep billing accurate and protect their revenue:

Global OB Package

• Know what’s included (prenatal, delivery, postpartum).
• Bill separately only for services outside the package (e.g., unrelated complications).

Documentation

• Clearly document complications, risk factors, and multiple gestations.
• Use specific terms (e.g., “diet-controlled gestational diabetes”) for correct coding.

Modifier Use

• Apply Modifier 25 for same-day preventive + problem visits.
• Use Modifier 59/XU for distinct procedures not normally billed together.

Coding Accuracy

• Stay updated with annual CPT and ICD-10 changes.
• Verify codes before submission with a scrubbing tool.

Prior Authorizations

• Confirm approval for surgeries, imaging, and infertility treatments before scheduling.

Payer-Specific Rules

• Maintain a reference sheet for major insurers (OB package rules differ).
• Adjust claims per payer requirements.

Claim Submission

• File claims within 24–48 hours of service.
• Double-check eligibility and benefits in advance.

Denial Management

• Track denials and root causes.
• Appeal quickly with proper documentation.

Patient Collections

• Verify coverage and explain patient responsibility upfront.
• Offer payment plans and online payment options.

Audit Readiness

• Keep detailed, accurate records for every service.
• Regularly review compliance with payer and Medicare/Medicaid rules.

Conclusion:

At the end of the day, OB/GYN practices succeed when their coding tells payers exactly what was done and why it was done. Using the correct OBGYN CPT codes and linking them with precise diagnosis codes means fewer disputes, faster reimbursements, and clearer bills for patients. Staying consistent with documentation and applying the right rules for billing protects both revenue and reputation. For providers, clean and accurate coding is not just about getting paid; it’s about building a billing system that runs smoothly in the background, so the focus can stay where it belongs: on patient care.