- December 17, 2025
- Posted by: Josh Knoll
- Category: Gynecology
Obstetrics and gynecology (OBGYN) billing undergoes continuous changes and updates. Just when everything seems under control, new rules arrive again. That’s where we are heading into 2026. CMS and the AMA have released new updates, and whether you like it or not, they affect how OBGYN practices prepares claims and secure reimbursement. Some of these changes are small; others can seriously impact revenue. Let’s go over what’s new and what it actually means for your billing team.
Why OBGYN Billing Feels More Important in 2026
OBGYN offices face unique hurdles. They manage pregnancy care, checkups, surgeries, and now virtual visits, too. Each service needs specific codes and detailed notes. This year, things got busier with over 487 new ICD-10-CM codes, 38 new revisions, and 28 deleted codes. Many focus on women’s health, like heart problems during pregnancy or delivery complications, according to CMS data from January 2025.
The AMA will also roll out 288 fresh CPT codes in 2026. These cover new tools like telemedicine and genetic tests, as noted in their latest update. These changes aim to make billing more precise. But they can overwhelm obstetricians and gynecologists’ offices if teams aren’t ready. Getting this right matters for faster payments and fewer headaches. Practices that catch up fast save time and patients trust the process. This piece shows why staying sharp now sets you up for success later.
Related Reading: Major Components of OBGYN Medical Billing Services
Big Regulatory Shifts from CMS in 2026
The CMS has published some major updates for 2026 that also impact OBGYN billing. Among others, one key move is ensuring that more prenatal and postpartum visits can happen online. It is especially applicable for patients in remote areas or with tough schedules. CMS wants to make care easier to reach. This year, they also set new rules for billing these virtual visits the same as in-person ones, as per their Medicare Physician Fee Schedule from November 2024.
Another big deal is billing for opioid use disorder, or OUD, treatment. OBGYN offices must add an OUD diagnosis code to claims now. This step keeps Medicare happy and stops rejections. CMS also created a new HCPCS add-on code for managing infectious diseases during hospital stays. It might apply to risky pregnancies. These rules show CMS cares about better outcomes. But they add work for billing teams.
Billing specialists can handle this by checking CMS rules monthly. Set a team meeting to talk through changes. Use free CMS tools, like their latest Final Rule, for details. Host a training day, too. It helps staff learn new codes and steps. Staying on top turns these challenges into chances to shine.
AMA’s CPT Code Tweaks: What OBGYN Teams Should Know
As mentioned, the AMA updated its CPT codes for 2026 with a total of 418 changes. They introduced 288 new CPT codes, 84 deletions, and 46 tweaks. A lot of these zero in on OBGYN work, reflecting new ways to help patients. New codes cover video calls, quick virtual chats, and belly surgeries, for example. These updates let OBGYN offices prepare claims for modern care accurately.
A cool part is the growth of Category III codes for cutting-edge stuff. They handle things like genetic tests for high-risk pregnancies. Coders need to get comfy with these fast to avoid slip-ups. The AMA also refreshed evaluation and management codes, which OBGYN teams use every day. OBGYN billing services must know that notes matter more now to pick the right code.
To make this work, coding staff should grab the AMA’s 2026 Coding Manual or check ACOG resources. Physicians should organize a workshop for their internal coders. They should build a quick guide listing the top OBGYN CPT Codes. The guidebook should include up-to-date codes (Like 59400 for prenatal care or 59510 for C-sections). They should also conduct frequent internal audits. It will help them catch unintended errors before financial damage. These moves build confidence and keep claims moving smoothly.
ICD-10-CM Updates: Pinpointing Details in OBGYN Coding
ICD-10 didn’t just change in 2026; rather, it grew a lot. Several new codes directly affect OBGYN billing. New codes break down heart failure types in pregnant patients, for instance. It helps doctors note conditions exactly right. This precision cuts down on rejections, but it demands care.
CMS warns that wrong ICD-10 codes top the list for claim problems. Moreover, payers deny many OBGYN claims because the diagnosis and procedure codes don’t match. Hence, coders must pair CPT codes with the correct ICD-10 codes for extreme accuracy. Linking those right shows payers why the rendered services are medically justified.
OBGYN medical billing and coding services should use coding software that spots potential mistakes. Review your ICD-10 notes every few months. Team up with coding pros who know OBGYN inside out. The ACOG’s 2026 OBGYN Coding Manual has tables and tips for quick help. Focusing on accuracy keeps denials low and cash flow steady. Practices should perform the following tasks:
- Invest in tech that ties into your billing system.
- Train your team on the new codes and what to document.
- Tell patients how virtual care helps to get them on board.
- Work with insurers to clear up coverage details.
These steps keep billing smooth and patients happy. Telehealth can be a win for all if handled right.
Global OB Care Bundles: Easier but Tricky to Bill
Global OB care packages still anchor OBGYN billing. Among them, codes like 59400 for vaginal births cover prenatal visits, delivery, and postpartum care. It simplifies things by grouping different care services for newborns together. But it hides traps, too. OBGYN coders should not bill extra E/M codes unless something unusual happens, like a switch in insurance.
In 2026, CMS and AMA stress using global codes correctly to dodge audits. Teams must log each service clearly, even inside a package, to back up claims. Modifiers might be needed for twins or complications, adding layers. Furthermore, OBGYN practices should make a checklist for global package billing. They need to use EHR systems to track every step and ensure nothing slips. They must also run regular checks to stay compliant. Above all, partnering with OBGYN billing wizards will empower them to maintain optimum coding accuracy at a significantly reduced cost.
Modifiers and Notes: Dodging Common Snags
Modifiers are key in OBGYN billing this year. They add info, like when services happen on the same day or involve more than one baby. CMS tightened rules for modifiers like 25 and 59. Coding teams need clear notes to avoid denials. Modifier 25 flags a separate office visit, but overuse can trigger reviews.
Coders must learn to use modifiers correctly, like KX for gender-specific care. Every modifier needs solid backup in notes, including photos or reports for ultrasounds, per AMA rules. Internal staff should build a modifier guide tailored for OBGYN work. They should hold training to cover typical cases and use billing tools with error alerts for modifiers. Moreover, they should audit often to catch issues early. These habits build trust with payers and protect your funds.
Related Reading: Smarter OBGYN Medical Billing Services for Complex Surgical Claims
Outsource OBGYN Medical Billing to SunKnowledge: A Smart Move for 2026 Challenges
Some OBGYN offices struggle to keep up with 2026’s rules. Outsourcing billing to pros can solve that. SunKnowledge Inc., with about two decades of experience in OBGYN billing and coding, specializes in this stuff. We handle codes, claims, and denials, following CMS and AMA standards. Our reputation ensures the following benefits:
- Our outsourced experts stay current on rules and catch errors.
- We ensure about 99% OBGYN billing and coding accuracy.
- We conduct internal audits to catch errors at an initial stage.
- Our records reflect about 97% first-pass acceptance rates.
- We offer OBGYN coding and RCM for only $7 per hour.
- Our affordable pricing helps practices reduce operational costs by 80%.
Outsourcing OBGYN medical billing services to SunKnowledge is a smart, affordable way to scale up, perfect for busy practices. If you are looking for an efficient coding and billing solution, connect with us. Our billing experts will streamline your revenue cycle, and your process will be future-ready.