OBGYN CPT Codes + Modifiers 2025

Last Updated on September 8, 2025 by admin

OB/GYN coding spans the full spectrum of women’s healthcare, from well-woman exams to pregnancy, delivery, surgery, and fertility care. Each CPT code carries weight in reimbursement, compliance, and revenue. Accuracy is the difference between smooth claims and weeks lost in AR.

CPT codes are defined by the American Medical Association, and in OB/GYN they cover preventive, obstetric, surgical, and fertility services. This guide organizes the most important OBGYN CPT Codes by stage of care.

Preventive and Screening OBGYN CPT Codes

Preventive visits and screenings are the entry point for many OB/GYN encounters. These codes track everything from Pap smears to pelvic ultrasounds, and accuracy here sets the tone for a claim’s success.

Office and Preventive Visits

99202–99215 — Office visits, problem-based, chosen by time or MDM.
99381–99397 — Preventive visits, new or established, age-based.

Preventive visits include history, exam, counseling, and risk reduction. If a problem is addressed at the same visit, a separate E/M with modifier 25 is allowed.

Preventive visits are prone to denials when ICD-10 codes don’t align. Strong eligibility verification ensures screening services are covered before claims go out.

Pap Smear and Cytology

88141–88175 — Cytology (Pap smear, with variations for manual vs. automated).
87624, 87625 — HPV DNA testing, often paired with Pap smears.

Common pitfall: billing Pap smears with screening ICD-10 when the visit was diagnostic. This mismatch leads to denials. Documentation must show medical necessity and purpose.

Colposcopy and Biopsy

57452–57461 — Colposcopy, with or without biopsy/curettage.

Documentation should specify “with biopsy” or “with ECC.” Missing this detail defaults coding to the lowest level, reducing reimbursement and creating underpayments that require recovery efforts.

OB/GYN Ultrasound

76830 — Transvaginal ultrasound
76856 — Complete pelvic ultrasound
76801, 76805 — First and second/third trimester OB ultrasounds

Ultrasounds require careful diagnosis linkage. A “routine pregnancy” ICD-10 differs from “threatened abortion,” and the wrong link can hold claims in AR.

Pregnancy and Delivery CPT Codes

Pregnancy coding is unique because many services are bundled into global packages. Coders must know when global billing applies and when to use split care codes to prevent denials.

Global OB Care Codes

59400 — Vaginal delivery, antepartum + postpartum.
59510 — Cesarean delivery, antepartum + postpartum.
59610 — VBAC with routine antepartum/postpartum.
59618 — Attempted VBAC, cesarean performed.

Global packages only apply when the same provider delivers all components. If care is shared, separate coding is required. ACOG provides guidance on global package usage.

Incorrect global billing is a top source of denials in OB. Practices with strong denial management reclaim revenue when payers dispute bundled claims.

Antepartum and Postpartum Codes

59425 — Antepartum only, 4–6 visits.
59426 — Antepartum only, 7+ visits.
59430 — Postpartum care only.

Visit counts matter. Coding 59425 for a patient with 7 visits triggers payer scrutiny. Tracking each visit avoids errors.

OB Ultrasound in Pregnancy

76815 — Limited ultrasound (heartbeat, amniotic fluid).
76816 — Follow-up ultrasound (growth or prior abnormality).

Payers often request justification. Notes like “follow-up scan for low-lying placenta” make medical necessity clear and reduce AR delays.

OBGYN Surgical CPT Codes

Surgical procedures require attention to detail. The approach, specimen count, and modifiers all affect coding. A single missed detail in the operative note can cause weeks of AR backlog.

Hysterectomy

58150–58294 — Range of abdominal, vaginal, laparoscopic, and radical hysterectomies.

Surgeons often abbreviate techniques (e.g., “TLH”). Coders must match shorthand to full CPT descriptions. Inaccurate coding leads to payer downcoding.

Myomectomy and D&C

58140, 58145 — Myomectomy, dependent on number/size of fibroids.
58120 — Dilation and curettage, diagnostic or therapeutic.

If fibroid sizes aren’t documented, coders must default to the lowest-paying code, causing preventable underpayments that need appeal and recovery.

LEEP and Biopsy

57522 — LEEP procedure.
58100 — Endometrial biopsy.

Both require pathology documentation for medical necessity. Missing notes often lead to payer denials.

Laparoscopic Procedures

58661 — Laparoscopic oophorectomy.
58670 — Laparoscopic tubal cautery/ligation.

Multiple laparoscopic services in one session require modifiers (59 or 51). Without them, payers bundle services, leading to reduced payments. The CMS Physician Fee Schedule outlines bundling edits.

Fertility and Contraception CPT Codes

Family planning and infertility services require precise documentation. Payers often scrutinize these claims closely due to cost and patient-pay responsibility.

IUD and Implant Codes

58300, 58301 — IUD insertion/removal.
11981, 11982 — Implant insertion/removal.

Lot numbers and product details must be recorded. Missing this information is a common reason for claim rejections.

Tubal Ligation Codes

58600, 58615 — Tubal ligation standalone or at cesarean.

Errors occur when ligation is billed alongside delivery without correct modifiers. Coders should verify operative notes carefully.

Fertility and IVF Codes

58321, 58322 — Artificial insemination.
58970 — Oocyte retrieval.
58974 — Embryo transfer.

These are high-value services often outside payer coverage. Eligibility checks and upfront patient counseling prevent AR backlogs and unpaid balances.

Practices with strong AR management handle these balances effectively and keep revenue flowing.

Important Modifiers

Modifiers explain circumstances payers don’t see in the CPT code itself. In OB/GYN, correct modifier use can prevent bundling errors, denials, and audits.

Modifier 22 – Increased Procedural Service

Used when a procedure is significantly more complex or time-consuming than usual.
Example in OB/GYN: A cesarean delivery complicated by extensive adhesions or uncontrolled hemorrhage.
Documentation must: Detail the unusual complexity, operative time, and clinical justification.
Revenue impact: Can increase reimbursement, but only if payers accept the justification.

Modifier 25: Significant E/M on Same Day

Used when a problem-oriented E/M service is provided during the same visit as a preventive service or minor procedure.
Example, a patient may come in for a Pap smear (preventive), but the provider also treats an acute UTI.
Documentation must: Clearly separate preventive vs. problem work. Include a distinct HPI, assessment, and plan for the problem visit.
Why it matters: Without this, payers bundle everything into preventive, leaving the E/M unpaid. A well-placed line in the note, “Acute cystitis treated beyond preventive scope”, protects revenue.

Modifier 53 – Discontinued Procedure

Applied when a procedure is started but discontinued due to patient safety or other extenuating circumstances.
Example: A D&C aborted because of excessive bleeding risk.
Documentation must: Explain why the procedure was discontinued and at what stage.
Denial prevention: Prevents payers from assuming the full service was delivered.

Modifier 79 – Unrelated Procedure During Post-Op Period

Used when a patient returns for an unrelated procedure during the global surgical period.
Example: A patient who had a cesarean (global package) later undergoes IUD insertion.
Documentation must: Clarify that the service was unrelated to the prior surgery.

Modifier misuse is one of the most common reasons for claims not being paid. A strong coding support team ensures documentation justifies every modifier.

OB/GYN coding stretches across the entire spectrum of women’s health, from preventive exams to complex fertility treatments. Every CPT code is more than a number, it’s revenue tied to documentation, compliance, and patient care. Practices that invest in coding accuracy and proactive revenue cycle processes don’t just reduce denials and underpayments, they create a steady foundation for sustainable growth.