OB/GYN Billing Services in New York

New York's ob/gyn practices face unique billing challenges shaped by Empire BlueCross BlueShield's commercial rules, NY Medicaid Managed Care requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both NY payer rules and ob/gyn coding complexity.

AAPC Certified
NY Payer Expert
OB/GYN Specialists
2.49% Rate
90,000+NY Physicians
2.49%Starting Rate
6Medicaid MCOs
98%+Clean Claim Rate

Why New York OB/GYN Practices Need Specialized Billing

New York's healthcare market includes 90,000+ physicians, and ob/gyn practices here face a payer market dominated by Empire BlueCross BlueShield on the commercial side and NY Medicaid Managed Care on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect ob/gyn procedure coverage and medical necessity requirements. Generic billing teams without NY specific knowledge leave revenue on the table.

OB/GYN billing itself is complex. Obstetric billing uses global maternity codes (59400 vaginal, 59510 cesarean, 59610 VBAC) that bundle antepartum visits, delivery, and postpartum care. But high-risk antepartum visits, complications, and procedures outside the global package can be billed separately with the right documentation. Gynecologic billing covers office procedures (colposcopy, endometrial biopsy), surgery (hysterectomy, laparoscopy), and preventive care. When you combine this coding complexity with New York's specific payer rules, authorization requirements, and 6 NY Medicaid Managed Care managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving ob/gyn practices from New York City to Albany and across New York.

Top CPT Codes for OB/GYN in New York

Our NY coders handle these ob/gyn codes daily, applying Novitas Solutions Medicare rules and Empire BlueCross BlueShield commercial policies to each claim.

Code
Description
59400
Routine obstetric care (vaginal delivery, global)
59510
Cesarean delivery (global)
59610
VBAC (vaginal birth after cesarean, global)
59025
Fetal non-stress test
57454
Colposcopy with biopsy
58558
Hysteroscopy with biopsy
58571
Laparoscopic hysterectomy
76801
OB ultrasound, first trimester

New York Payer Challenges for OB/GYN

Every NY payer has specific rules for ob/gyn claims. Here's how we navigate them.

Empire BlueCross BlueShield OB/GYN Claims

Empire BlueCross BlueShield processes the largest share of New York commercial ob/gyn claims. We know their NY specific fee schedules, prior authorization requirements for ob/gyn procedures, and their appeal timelines when claims are denied. The OB global includes 13 antepartum visits, delivery, and postpartum. Unbundling errors in either direction cause denials.

NY Medicaid Managed Care OB/GYN Billing

NY Medicaid Managed Care routes ob/gyn patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, and 3 more. Each MCO has its own ob/gyn authorization and billing rules that we manage.

Medicare (Novitas Solutions) OB/GYN Coverage

Novitas Solutions processes Medicare ob/gyn claims in New York with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around high-risk add-ons to prevent medical necessity denials.

Denial Prevention for New York OB/GYN

Common ob/gyn denials in New York include antepartum visit billed outside global without documentation and high-risk condition not coded as secondary diagnosis. Our team catches these issues before submission and appeals aggressively with NY payer-specific documentation when denials occur.

Get Expert OB/GYN Billing in New York

Free billing assessment for your NY ob/gyn practice. See where revenue is leaking.

98%+ clean claim rate
2.49% starting rate
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What We Handle for New York OB/GYN Practices

Obstetric global package management
High-risk pregnancy coding and billing
Gynecologic office procedure coding
Surgical gynecology (hysterectomy, laparoscopy)
OB ultrasound and fetal testing billing
Colposcopy and cervical biopsy coding
Preventive GYN visit optimization
Prior auth for GYN surgery and imaging

New York OB/GYN Billing Cost Comparison

Hiring an in-house biller with ob/gyn expertise in New York costs $45K-$62K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified ob/gyn coders and NY payer specialists for a fraction of that cost.

$45K-$62K

In-House Biller Salary

+ benefits, software, space

2.49%

Go Medical Billing Rate

Full team, all services included

60-80%

Typical Cost Reduction

With better results

Frequently Asked Questions

All major NY payers: Empire BlueCross BlueShield, Aetna, Cigna, UHC, EmblemHealth, Oxford, NY Medicaid Managed Care (including Fidelis Care, Healthfirst, MetroPlus), and Medicare through Novitas Solutions. If a payer accepts ob/gyn patients in New York, we submit and follow-up on claims with them.
The most frequent ob/gyn denials we see from NY payers include antepartum visit billed outside global without documentation, high-risk condition not coded as secondary diagnosis, ultrasound medical necessity not established. Our team catches these before submission by applying both ob/gyn coding expertise and NY payer-specific rules to every claim.
NY Medicaid Managed Care routes ob/gyn patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, Molina, MVP, United. Each MCO has its own ob/gyn authorization requirements, fee schedules, and billing rules. We credential and bill with all of them so your ob/gyn practice gets paid correctly.
Most NY ob/gyn practices are fully transitioned within two to three weeks. We connect to your EHR, learn your ob/gyn workflows, and start submitting claims to Empire BlueCross BlueShield, NY Medicaid Managed Care, Medicare, and all your NY payers with no downtime.

Fix Your New York OB/GYN Billing

Call 888-701-6090 for a free billing assessment specific to your NY ob/gyn practice. We'll show you where revenue is leaking and how to fix it.