medical billers and coders Visit our website: Click here Follow us: OB-GYN BILLING SERVICES · TEXAS OBGYN Billing Services in Texas Specialized Revenue Cycle Management for Texas Obstetrics & Gynecology Practices medicalbillersandcoders.com | 888-357-3226 | Published: March 29, 2026 Texas OB-GYN Practices Face 22% Claim Denial Rates Global maternity packages, high-risk pregnancy documentation, and AI-assisted payer audits create a revenue cycle where small coding gaps compound into significant, recurring losses. MBC provides OB-GYN billing services across Texas — from solo obstetrics practices in San Antonio to multi- physician women's health groups in Houston and Dallas. We act as your Revenue Integrity Partner, managing global maternity packages, gynecologic surgery coding, high-risk pregnancy documentation, and payer-specific denial workflows so your clinical team can stay focused on patient care. MARKET CONTEXT Bundling rules vary by payer and require exact antepartum visit counts, split-package protocols for transfers, and documentation for separately billable services within the global period. Additional monitoring, specialist co-management, and extended visits require precise documentation to establish medical necessity for separately billable services. Texas presents billing challenges specific to obstetrics and gynecology that generic billing teams — and in-house billers managing multiple specialties — are consistently underprepared for: Why OB-GYN Billing Is Harder in Texas ■ ■ High-Risk Pregnancy Documentation Global Maternity Package Complexity 1 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 ■ medical billers and coders Visit our website: Click here Follow us: 2 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 Texas Medicaid operates through multiple MCOs — Molina, Superior HealthPlan, UnitedHealthcare Community Plan, Driscoll Health Plan — each with distinct global package definitions and prior auth requirements. ■ Medicaid MCO Payer Fragmentation Texas extended postpartum Medicaid from 2 months to 12 months in 2024 — creating substantial new billing opportunity many practices have not yet captured in their workflows. ■ 2024 Postpartum Medicaid Expansion ■ Modifier Misuse & NCCI Edit Exposure Modifier -25, -59, -52, -24, and -95 are the most commonly misapplied in Texas OB-GYN billing. Incorrect usage is a top-3 cause of claim denials in the specialty. ■ Legal Environment & Emergency Documentation Texas's reproductive care laws create a unique documentation environment for emergency pregnancy complications, requiring billing teams that understand the intersection of state law and payer medical necessity standards. Many Texas OB-GYN practices have not updated eligibility verification workflows or billing protocols to reflect this change — causing postpartum claims to deny when coverage was actually active. MBC verifies postpartum Medicaid eligibility at every visit and bills within the correct coverage window. ■ 2024 KEY CHANGE: Texas Postpartum Medicaid Extended to 12 Months medical billers and coders Visit our website: Click here Follow us: 3 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 Antepartum Visit Miscounts Payers track antepartum visit counts within the global package. When a patient transfers mid-pregnancy, delivers prematurely, or changes practices, the global package must be split and visits billed individually using modifier -52 or -53. Missing this creates overpayments or underpayments on both ends. Global obstetric package billing (CPT 59400, 59510, 59610) Antepartum and postpartum visit coding High-risk pregnancy billing and documentation Gynecologic surgery coding (hysterectomy, laparoscopy, LEEP) Preventive women's health billing Diagnostic ultrasound and fetal monitoring billing Infertility evaluation and treatment coding Telehealth OB-GYN visit billing (POS 02/10, modifier -95) Medicaid MCO prior authorization management Postpartum Medicaid eligibility verification Denial management and modifier- specific appeals A/R follow-up and aging recovery Credentialing and payer enrollment HIPAA-compliant reporting and dashboards The global obstetric package is the single largest source of billing revenue — and the single largest source of preventable revenue loss — for most Texas OB-GYN practices. Revenue problems arise at four specific points: COMPLETE RCM COVERAGE REVENUE RECOVERY FOCUS OBGYN Billing Services We Handle in Texas Global Maternity Billing in Texas: Where Revenue Gets Lost MBC works within your existing EHR — eClinicalWorks, Athena, NextGen, Epic, Medisoft, or another platform. You don't change your software or front-desk workflow. 1 2 Separately Billable Services Billed Inside the Package High-risk monitoring, cerclage, non-stress tests beyond what the package covers, and certain diagnostic ultrasounds are separately payable — but only with documentation establishing they fall outside the standard package. medical billers and coders Visit our website: Click here Follow us: 4 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 3 4 Delivery Coding Errors Vaginal delivery (CPT 59400), C-section (CPT 59510), VBAC (CPT 59610), and their assisted and complex variants each carry distinct global package definitions. Coding a VBAC as a standard vaginal delivery, or missing documentation for a medically necessary C-section, triggers denials that are difficult to recover after the fact. Separately Billable Services Not Billed at All The inverse problem is equally common: services legitimately outside the global package go unbilled because billing teams apply global package rules too broadly. Chronic disease management during pregnancy, unrelated acute encounters, and advanced imaging are often recoverable revenue that never appears on a claim. Texas Medicaid MCOs do not use identical global package definitions. What Superior HealthPlan includes differs from Molina and UnitedHealthcare Community Plan. MBC maintains payer-specific global package profiles for every major Texas MCO, updated as coverage policies change. Texas Payer Note: ■ AUDIT INTELLIGENCE What a Revenue Diagnostic Finds in a Typical Texas OB-GYN Practice Global package antepartum visit counts incorrect for transferred patients — generating underpayment or overpayment exposure Postpartum Medicaid eligibility not verified at 2-month visits — claims denied when 12-month extended coverage was actually active High-risk monitoring and non-stress tests bundled into the global package when documentation supports separate billing Modifier -25 missing on E&M; services billed the same day as gynecologic office procedures (IUD insertions, colposcopies, cryotherapy) Telehealth prenatal and postpartum visits billed without POS 02 or modifier -95 — generating payer rejections on a growing visit volume Infertility evaluation services denied for missing prior authorization with BCBS Texas or Aetna — with no appeal filed Gynecologic surgery claims using outdated CPT codes from the 2024 update cycle — denying on submission with no clear error message ! ! ! ! ! ! ! medical billers and coders Visit our website: Click here Follow us: 5 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 A Revenue Diagnostic identifies where your Texas OB-GYN practice is losing money — with payer- specific data from your actual claims, not industry averages. It takes about 15 minutes of your time. STATEWIDE COVERAGE OB-GYN Billing Coverage Across Texas Houston Dallas San Antonio Austin El Paso • Arlington • Plano • Lubbock • Laredo • Irving • Garland • Frisco • McKinney • Amarillo • Grand Prairie • Brownsville • Pasadena • Killeen • McAllen • Mesquite • Midland • Odessa • Beaumont • Round Rock • Waco • Denton • Carrollton • Lewisville • Sugar Land If your practice is in a city not listed above, contact MBC — our Texas billing team covers the entire state, including rural markets where OB-GYN provider shortages create additional billing complexity. TRANSPARENT PRICING What Outsourcing OB-GYN Billing in Texas Costs — and What It Returns Industry average billing vendor fee (% of net collections) MBC's model — you pay only on revenue recovered, not claims submitted Setup fees — no long- term contracts before results are demonstrated Typical timeframe to see denial rate improvement after transition to MBC 4–7% Per-Collection $0 60–90 Days medical billers and coders Visit our website: Click here Follow us: 6 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 FREQUENTLY ASKED QUESTIONS OB-GYN Billing in Texas: Key Questions Answered Modifier -25 is most frequently missing — required when a separately identifiable E&M; is billed the same day as a gynecologic procedure (IUD insertion, colposcopy, LEEP, cryotherapy). Modifier -59 distinguishes services otherwise bundled under NCCI edits. Modifier -52 applies to reduced services such as a partial antepartum care package. Modifier -95 is required for synchronous telehealth services in Texas. Texas extended postpartum Medicaid coverage from 2 months to 12 months in 2024. Postpartum visits, contraceptive counseling, and related gynecologic services are now billable to Medicaid through 12 months after delivery. Many practices have not updated eligibility verification workflows, causing covered postpartum claims to be denied when coverage was actually active. The global package bundles antepartum care (typically 13 visits), delivery, and 6 weeks of postpartum care into a single payer reimbursement. Errors occur when practices incorrectly count antepartum visits for patients who transfer mid- pregnancy, fail to separately bill services that fall outside the package, or apply a single set of billing rules across all Texas Medicaid MCOs — each of which uses a different global package definition. MBC coders identify high-risk conditions from clinical documentation and ensure qualifying separately billable services are captured with the documentation required to satisfy Texas payer medical necessity standards. MBC also maintains current knowledge of which Texas commercial payers and Medicaid MCOs require prior authorization for high-risk monitoring services. Q: How does MBC handle high-risk pregnancy billing in Texas? Q: What modifiers are most commonly misused in Texas OB-GYN billing? Q: How did Texas's 2024 postpartum Medicaid expansion change OB-GYN billing? Q: What istheglobalobstetricpackageandwhydoesitcausesomanybillingerrorsinTexas? Q: Does MBC bill for telehealth OB-GYN visits in Texas? Yes. Telehealth billing requires specific place-of-service codes (POS 02 for telehealth other than in patient's home, POS 10 for patient's home), modifier -95 for synchronous telemedicine, and documentation of the platform used and patient consent. MBC applies the correct POS and modifier combination by payer for every telehealth encounter. OB-GYN practices across Texas trust MBC to manage their complete revenue cycle — from global maternity billing through gynecologic surgery coding and postpartum Medicaid recovery. Stop Losing Revenue on Global Packages. Start Recovering It. Request a Free Revenue Diagnostic Today Phone: 888-357-3226 | Email: info@medicalbillersandcoders.com