Global package billed twice
A physician bills the global after a hospital transfer and the midwife's claim is denied as duplicate. We bill antepartum-only and delivery-only components with transfer dates documented so both providers are paid.
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Midwifery medical billing services
Midwifery billing is organized around the global obstetric package and all the ways a pregnancy breaks out of it: transfers of care, early arrivals, hospital transfers from a planned home birth and multiple attending providers. Certified nurse midwives bill Medicare at the physician rate, but Medicaid and commercial plans each handle midwives differently.
What makes midwifery billing different
Pregnancy care is billed as one package until something changes, and midwives see those changes more often than most practices.
- Global codes 59400 for vaginal delivery, 59510 for cesarean and 59610 or 59618 for VBAC include antepartum, delivery and postpartum care, so routine prenatal visits must not be billed separately as E/M services.
- When care is split, antepartum-only codes 59425 for four to six visits and 59426 for seven or more, delivery-only 59409 or 59410 and postpartum-only 59430 replace the global, and the number of documented visits must support the code.
- Birth center deliveries bill the professional service with POS 25 and the facility charge separately, home births use POS 12, and some Medicaid plans require modifier SB to identify the nurse midwife as the rendering provider.
- Diagnosis coding needs the trimester-specific O code plus a Z3A weeks-of-gestation code on every claim, and newborn care 99460 to 99463 and attendance at delivery 99464 are billed under the newborn's own coverage once it is established.
Denials we see most in midwifery
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Midwife not recognized
Plans that have not credentialed the midwife or do not cover certified professional midwives reject the claim. We verify midwife coverage by plan during benefits checks and complete enrollment before the first prenatal visit.
Missing gestational age
Claims rejected for an O code without a Z3A code or trimester mismatch. We scrub every maternity claim for the pairing before submission.
How Core MB bills for midwifery
Core MB bills midwifery practices with a team that tracks each pregnancy from the first visit, knows when the global applies and when it breaks apart, and codes birth center and home birth claims correctly. Credentialing for new midwives runs in the same portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Pregnancy episodes tracked by estimated due date so global and component codes are chosen at delivery, not guessed.
- Transfer of care dates recorded the day they happen so split claims go out clean.
- Midwife coverage and newborn enrollment verified by plan before the delivery date.
Everything in the service
From benefit verification in early pregnancy through global and component claims, newborn billing, denials, posting, statements and reporting, with credentialing handled by the same team.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Midwifery billing questions
How do we bill when a home birth transfers to the hospital?
The midwife bills antepartum care with 59425 or 59426 by visit count and, if present and documented, delivery assistance under the appropriate code. The hospital provider bills the delivery. We document the transfer date and reason so neither claim is denied as a duplicate global.
Why does Medicaid pay our midwives differently from commercial plans?
Each state Medicaid program sets its own midwife policy, including whether certified professional midwives are covered, whether modifier SB is required and how birth center facility fees are paid. We keep the rule set for your state and bill each plan the way it expects.
Can we bill prenatal visits as E/M if the patient leaves before delivery?
Not as E/M. When the global will not be completed, the antepartum-only codes replace it based on the number of documented visits. We hold prenatal charges until the outcome is known and bill the right component once the patient transfers or delivers.
How do we get started with Core MB for midwifery billing?
Send your midwife count, delivery settings and monthly births through the quote form and we will reply with a written proposal. Transitions run alongside your current billing so no pregnancy is dropped mid-episode, and credentialing for new midwives can start at the same time.
Every pregnancy billed correctly from first visit to postpartum
Core MB tracks the global package, the transfers and the newborn so midwives are paid for the whole episode of care.