OB/GYN CPT Codes for 2026 + Modifiers
Jan 19, 2026
Technically Reviewed By:
Last Updated: October 29, 2026
Kristen is a Senior Account Manager with 25 years of experience in the healthcare industry. She specializes in commercial insurance resolution, helping practices navigate payer disputes, denials, audits, and other revenue challenges.
OB/GYN billing spans preventive visits, prenatal management, fertility treatment, pelvic procedures, and high-risk maternal care, often within the same patient lifecycle. That range creates coding complexity, especially now, with more specific pelvic pain diagnosis codes in effect and the biggest change to maternity coding in decades arriving on January 1, 2027. If your team is still relying on outdated templates or generalized coding habits, this update will help align your most common OB/GYN CPT® codes and modifiers for 2026 with current payer expectations.
If you want a broader revenue-cycle view beyond code updates, explore dedicated OB/GYN medical billing services.
OB/GYN denials aren’t random. They follow predictable documentation gaps.
We consistently see denials related to same-day E/M + procedures, improper global obstetric billing splits, incomplete pelvic pain specificity, and modifier errors. These aren’t coding mysteries. They’re workflow breakdowns.
Guarantee: We’ll identify your top OB/GYN denial drivers and provide a clear correction plan.
Contact us to receive a Denial Snapshot showing exactly where reimbursement is breaking down.
Evaluation and Management (E/M) Codes Common in OB/GYN
OB/GYN practices frequently bill E/M services alongside procedures such as colposcopy, IUD insertion, endometrial biopsy, or pelvic exams. When billed separately, documentation must clearly support a distinct, medically necessary service.
| CPT® Code | Description |
|---|---|
| 99202–99205 | New patient office visits |
| 99212–99215 | Established patient office visits |
| 99221–99223 | Initial hospital inpatient or observation care |
| 99231–99233 | Subsequent hospital inpatient or observation care |
| 99238–99239 | Hospital inpatient or observation discharge day management |
| 99242–99245 | Office or other outpatient consultations (Medicare does not pay consultation codes) |
Documentation Tip: When billing E/M with a procedure, clearly separate the evaluation from the procedure note to support modifier -25.
Same-day E/M + procedures are one of the biggest OB/GYN denial triggers.
We routinely see 99213 to 99215 denied when billed with 57454, 58300, or 58100 because documentation doesn’t clearly justify modifier -25. Payers assume the visit was included unless proven otherwise.
Guarantee: We’ll identify why your E/M claims are being denied and show you how to structure documentation for approval.
Contact us to receive a targeted E/M denial review.
Well-Woman and Preventive Visit Codes
| Code | Description |
|---|---|
| 99384 / 99394 | Preventive visit, new / established patient, age 12 to 17 |
| 99385 / 99395 | Preventive visit, new / established patient, age 18 to 39 |
| 99386 / 99396 | Preventive visit, new / established patient, age 40 to 64 |
| 99387 / 99397 | Preventive visit, new / established patient, age 65 and older |
| G0101 | Medicare: cervical or vaginal cancer screening; pelvic and clinical breast exam |
| Q0091 | Medicare: screening Pap smear; obtaining, preparing, and conveying the specimen to the lab |
| 99000 | Handling or conveyance of a specimen to an outside lab (often bundled; payer-dependent) |
If a problem is addressed during a preventive visit, the problem-oriented E/M can be added with modifier -25 when the work is significant and separately documented.
Pelvic Exam Code (99459)
CPT® 99459 has been reportable since January 1, 2024. It is a practice expense-only add-on code that pays for the extra clinical staff time (including a chaperone) and supplies, such as a speculum, used during a pelvic exam.
| CPT® Code | Description | Billing Note |
|---|---|---|
| +99459 | Pelvic examination (practice expense only; add-on code) | Report with an office E/M service in a non-facility setting. Not reported with procedures such as IUD insertion or endometrial biopsy, or in facility settings. |
Document that a pelvic exam was performed and note the chaperone (or that a chaperone was offered and declined). Some commercial payers do not pay 99459 separately, so check each payer’s policy.
Administrative codes like 99459 deny when workflow isn’t updated.
We see practices forget to update encounter templates or misapply the non-facility rule, leading to rejected claims. Small compliance errors add up quickly.
Guarantee: We’ll review your administrative coding and flag compliance risks.
Obstetric Global and Delivery Codes (2026)
The global obstetric CPT® codes remain in effect for all of 2026. They are deleted on January 1, 2027 (see below).
| CPT® Code | Description |
|---|---|
| 59400 | Routine obstetric care: antepartum care, vaginal delivery, and postpartum care |
| 59409 | Vaginal delivery only |
| 59410 | Vaginal delivery only, including postpartum care |
| 59425 | Antepartum care only, 4 to 6 visits |
| 59426 | Antepartum care only, 7 or more visits |
| 59430 | Postpartum care only |
| 59510 | Routine obstetric care: antepartum care, cesarean delivery, and postpartum care |
| 59514 | Cesarean delivery only |
| 59515 | Cesarean delivery only, including postpartum care |
| 59610 | Routine obstetric care: antepartum care, vaginal delivery after previous cesarean (VBAC), and postpartum care |
| 59612 | VBAC delivery only |
| 59614 | VBAC delivery only, including postpartum care |
| 59618 | Routine obstetric care: antepartum care, cesarean delivery after attempted VBAC, and postpartum care |
| 59620 | Cesarean delivery only, after attempted VBAC |
| 59622 | Cesarean delivery only, after attempted VBAC, including postpartum care |
When care is split between practices, antepartum care of 1 to 3 visits is reported with E/M codes, 4 to 6 visits with 59425, and 7 or more with 59426. Report these once for the whole pregnancy, not per visit.
Watch Ahead: On January 1, 2027, the AMA deletes 17 maternity codes, including the global packages 59400, 59510, 59610, and 59618, adds 12 new codes, and revises 6. Prenatal visits will be billed individually, with new codes for labor management (59080 to 59083) and delivery (59431 to 59434, 59502 to 59504, and 59623). CMS has proposed separate Medicare G-codes, so Medicare billing may differ until the final rule is out. Practices should update templates and contracts now, especially for patients due in early 2027.
Global OB billing errors can delay thousands in reimbursement.
Improper splitting of antepartum, delivery, or postpartum services often triggers payer audits. We identify global billing breakdowns before they become revenue losses.
Guarantee: We’ll review your global OB billing workflow for compliance and revenue gaps.
Pelvic Pain ICD-10 Specificity Update
Since October 1, 2025, R10.2 is no longer a billable code. Pelvic pain must be reported with one of the new codes below, which capture laterality and suprapubic pain.
| ICD-10 Code | Description |
|---|---|
| R10.20 | Pelvic and perineal pain, unspecified side |
| R10.21 | Pelvic and perineal pain, right side |
| R10.22 | Pelvic and perineal pain, left side |
| R10.23 | Pelvic and perineal pain, bilateral |
| R10.24 | Suprapubic pain |
Use R10.20 only when the side is not documented. Unspecified diagnoses increase medical necessity denials.
Diagnosis specificity drives medical necessity approval.
We frequently see CPT®/ICD mismatches when unspecified pelvic pain codes are used despite clear documentation. These silent errors slow payment.
Guarantee: We’ll analyze your diagnosis patterns and identify preventable denials.
Common Gynecologic Procedures
| CPT® Code | Description |
|---|---|
| 57500 | Cervical biopsy, single or multiple, or local excision of lesion |
| 58100 | Endometrial sampling (biopsy), without cervical dilation, any method |
| 58300 | Insertion of intrauterine device (IUD) |
| 58301 | Removal of intrauterine device (IUD) |
| 58120 | Dilation and curettage (D&C), diagnostic and/or therapeutic (non-obstetric) |
| 57452 | Colposcopy of the cervix |
| 57455 | Colposcopy with biopsy(s) of the cervix |
| 57456 | Colposcopy with endocervical curettage |
| 57454 | Colposcopy with biopsy(s) of the cervix and endocervical curettage |
| 57522 | Conization of cervix, loop electrode excision (LEEP) |
| 58558 | Hysteroscopy, surgical, with endometrial biopsy and/or polypectomy, with or without D&C |
| 58563 | Hysteroscopy, surgical, with endometrial ablation |
| 58661 | Laparoscopy, surgical, with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) |
| +58611 | Tubal ligation or transection at the time of cesarean delivery or other intra-abdominal surgery (add-on code) |
| 11981 / 11982 / 11983 | Contraceptive implant: insertion / removal / removal with reinsertion |
High-frequency procedures create high-frequency denial risk.
We see recurring denials around IUD services, colposcopy documentation, and D&C global period misunderstandings. Repetition multiplies financial impact.
Guarantee: We’ll uncover the top denial patterns affecting your OB/GYN procedures.
Hysterectomy CPT Codes
| CPT® Code | Description |
|---|---|
| 58150 | Total abdominal hysterectomy, with or without removal of tube(s) and ovary(s) |
| 58180 | Supracervical abdominal hysterectomy, with or without removal of tube(s) and ovary(s) |
| 58260 | Vaginal hysterectomy, uterus 250 g or less |
| 58262 | Vaginal hysterectomy, uterus 250 g or less, with removal of tube(s) and/or ovary(s) |
| 58541 / 58542 | Laparoscopic supracervical hysterectomy, uterus 250 g or less / with removal of tube(s) and/or ovary(s) |
| 58550 / 58552 | Laparoscopic-assisted vaginal hysterectomy, uterus 250 g or less / with removal of tube(s) and/or ovary(s) |
| 58570 / 58571 | Total laparoscopic hysterectomy, uterus 250 g or less / with removal of tube(s) and/or ovary(s) |
| 58572 / 58573 | Total laparoscopic hysterectomy, uterus over 250 g / with removal of tube(s) and/or ovary(s) |
Ultrasound and Diagnostic Tests
| CPT® Code | Description |
|---|---|
| 76801 | Obstetric ultrasound, first trimester (under 14 weeks), transabdominal, single or first gestation |
| 76805 | Obstetric ultrasound, 14 weeks or later, transabdominal, single or first gestation |
| 76811 | Obstetric ultrasound with detailed fetal anatomic examination, transabdominal, single or first gestation |
| 76817 | Obstetric ultrasound, transvaginal |
| 76830 | Pelvic ultrasound (non-obstetric), transvaginal |
| 76831 | Saline infusion sonohysterography (SIS), including color flow Doppler when performed |
| 76856 | Pelvic ultrasound (non-obstetric), transabdominal, complete |
| 76857 | Pelvic ultrasound (non-obstetric), limited or follow-up (eg, IUD position) |
| 81025 | Urine pregnancy test, by visual color comparison |
| 87624 | HPV testing, high-risk types, pooled result |
| 88175 | Cervical or vaginal cytology (Pap), liquid-based, automated screening with manual rescreening |
OB/GYN Billing Modifiers That Prevent Denials
| Modifier | When It’s Commonly Used |
|---|---|
| -25 | Separate E/M on the same day as a procedure or preventive visit |
| -59 | Distinct procedural service |
| -XS / -XU | Medicare’s more specific alternatives to -59 (separate structure; unusual non-overlapping service) |
| -24 | Unrelated E/M during a global period |
| -51 | Multiple procedures |
| -22 | Increased procedural services, when documented work is substantially greater than usual |
| -76 / -77 | Repeat procedure by the same provider / by a different provider (eg, repeat ultrasound) |
| -33 | Preventive service (signals the payer to waive cost sharing where the ACA applies) |
| -TH | Obstetrical treatment or services, prenatal or postpartum (required by some Medicaid and commercial payers) |
| -26 | Professional component (eg, ultrasound interpretation only) |
| -TC | Technical component |
| -93 | Synchronous telemedicine service by real-time audio-only communication |
| -95 | Synchronous telemedicine service by real-time audio and video communication |
Modifiers are where OB/GYN claims commonly break down.
Improper use of -25, -24, and telemedicine modifiers often results in payer edits. Each payer interprets modifier rules differently.
Guarantee: We’ll identify your most common modifier-related denials and provide a correction plan.
Common ICD-10 Codes for OB/GYN
| ICD-10 Code | Description |
|---|---|
| Z34.90 | Encounter for supervision of normal pregnancy, unspecified, unspecified trimester |
| Z34.91 | Encounter for supervision of normal pregnancy, unspecified, first trimester |
| Z01.419 | Encounter for gynecological examination (general) (routine) without abnormal findings |
| Z12.4 | Encounter for screening for malignant neoplasm of cervix |
| Z30.430 | Encounter for insertion of intrauterine contraceptive device |
| Z30.09 | Encounter for other general counseling and advice on contraception |
| N80.9 | Endometriosis, unspecified |
| N84.0 | Polyp of corpus uteri |
| N92.5 | Other specified irregular menstruation |
| N93.9 | Abnormal uterine and vaginal bleeding, unspecified |
OB/GYN Billing Tips for 2026
- Use global maternity codes accurately based on the care provided, and report split care with the antepartum, delivery-only, and postpartum codes.
- Prepare for January 1, 2027: update templates, contracts, and charge capture for patients delivering in 2027.
- Apply -25 only when the E/M is significant and documented separately from the procedure.
- Use -59 (or -XS/-XU for Medicare) only when procedures are truly distinct, and check NCCI edits first.
- Replace R10.2 with R10.20 to R10.24 in every template.
- Add 99459 to office E/M visits with a documented pelvic exam, where payers recognize it.
- Use the correct screening versus diagnostic ICD-10 codes for Pap smears and well-woman visits.
Frequently Asked Questions
What is the CPT code for an endometrial biopsy in 2026?
58100 is endometrial sampling without cervical dilation. If the cervix is dilated, the procedure is reported as a D&C (58120), and a hysteroscopic biopsy is reported with 58558.
What are the IUD CPT codes for 2026?
58300 is IUD insertion and 58301 is IUD removal. Bill the device separately with its HCPCS J-code, and pair the insertion with Z30.430. Modifier -33 may apply under ACA preventive rules.
What is the CPT code for an OB visit?
Routine prenatal visits are included in the global obstetric codes (59400, 59510, 59610, 59618) through 2026. When the practice does not provide the full global package, 1 to 3 antepartum visits are billed with E/M codes, 4 to 6 with 59425, and 7 or more with 59426. Starting January 1, 2027, prenatal visits will be billed individually.
What is the CPT code for a tubal ligation during a cesarean section?
Report add-on code 58611 in addition to the cesarean delivery code.
Can you bill 58100 and 57500 together?
Sometimes. The two codes are paired in an NCCI edit. Check the current CMS NCCI table: if the edit allows a modifier, report 57500 with -59 (or -XS) and document that the cervical and endometrial biopsies were separate sites. If no modifier is allowed, only 58100 is paid.
Are global OB codes going away?
Yes. 59400, 59510, 59610, and 59618 are deleted on January 1, 2027, along with 13 other maternity codes. Each phase of maternity care will be billed separately. Medicare’s approach depends on the CMS 2027 final rule.
Final Thoughts
Keeping your OB/GYN CPT® codes and modifiers for 2026 current protects reimbursement, reduces denials, and ensures compliance as diagnostic coding gets more specific and maternity coding moves away from global packages in 2027. Small coding oversights can have outsized financial impact in maternity and gynecologic care.
If OB/GYN denials are increasing, the cause is usually systematic, not random.
Whether the issue involves E/M documentation, global OB billing, pelvic pain specificity, or modifier misuse, Quest National Services has seen these patterns repeatedly and corrected them quickly.
Guarantee: We’ll identify your top denial causes and give you a concrete fix plan.
Trademark notice: CPT is a registered trademark of the American Medical Association.
For informational purposes only.
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