2025 Obstetrics and Gynecology Billing Updates You Need to Know

Obstetrics and Gynecology Billing

You know how hard obstetrics and gynecology billing can be. You have unique procedures, tricky bundles, and rules that keep changing every year. You need to follow the latest CMS guidelines to get paid right and stay out of trouble. All you want to ensure is to face zero headaches at the time of handling obstetrics and gynecological billing services. 

You might be wondering about the recent updates rolled out by CMS in 2025. Fortunately, CMS has made the billing game easier for you in 2025. But you still need to watch the details. You will find the key rules, changes, and tips here to help make your OB-GYN billing simple.

The key updates on your obstetrics and gynecology billing process in 2025:

More emphasis on telehealth services:

You will notice CMS allowing you bill for more OB-GYN services using telehealth in 2025. You can use telehealth codes for things like prenatal and postpartum care. You need to add the right modifiers to show the services were done remotely. Make sure that you always check whether your patient’s insurance company covers telehealth services or not. You must write down everything in your patient note. 

Global maternity packages:  

You have heard of the global obstetrics and gynecology billing package. You are still expected to bill it as a single package that includes prenatal visits, delivery, and postpartum care. You need to know that CMS has updated the documentation requirements for these services. You must include detailed notes for each visit to prove the care provided. Make sure you are not billing twice for services already included in the maternity package you provided to your patient. 

New ICD-10 codes:  

As you know coding always plays one of the most vital roles in your obstetrics and gynecology billing practice, therefore you must stay on top of all the current coding guidelines. For example, you must assign the newly updated ICD-10 code O09.011 for documenting high-risk pregnancies in 2025. Before you send in any claims, make sure you double-check the new codes. You also need to teach your staff about these changes. If you code everything right, you will be able avoid denials. 

Stricter PA rules than last year:  

You are already familiar with prior authorizations. You need them for certain obstetrics and gynecological procedures like hysterectomies or fertility treatments. You should know that CMS has streamlined the process for some services in 2025. You can now submit electronic prior authorizations, which saves you time. You should still check with individual payers to see if they follow these updated rules. 

More focus on value-based care incentives:  

You are already familiar with the value-based care model that ensures improved patient care but the cherry on the cake is that now you will be able to earn bonuses by meeting the specific quality measures set by CMS in 2025. You need to track metrics like prenatal visit frequency and postpartum follow-ups. You will get paid more if you show you are providing high-quality care. .

You know how frustrating it is when claims get denied. You can follow these tips to avoid common mistakes in your billing process: 

  • Ensure accurate documentation 
  • Verify your patient’s insurance properly 
  • Obtain prior authorization approvals for specific OB-GYN procedures 
  • Stay on top of guidelines for using codes and modifiers 
  • Submit claims on time 
  • Implement a denial management process 

You might have already realized the hardcore reality that managing billing can be an overwhelming affair when you are managing it with an in-house team. You would barely be able to keep your head above water with the staffing shortage and ever-changing rules in 2025. The overall complexity of your billing job will only increase with new insurance payers entering the market in 2025. So, what could be the ideal solution for you? You can save time, reduce denials, and stay ahead of the changes by hiring a perfect obstetrics and gynecology billing company. You can always stay focused on patient care while ensuring your practice stays financially healthy by outsourcing your billing process. Let the pros handle the billing while you handle your patients and enjoy the competitive edge! 

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