Midwifery and Birth Center Billing Services

Midwifery billing depends heavily on state law and payer policy. Certified nurse-midwives, certified professional midwives and birth centers can each be paid differently, and some payers do not credential every midwife type. Medicaid rules often drive the business, and they vary from state to state.

Birth centers may bill for a professional service and a separate facility service, which doubles the claim work. Westmont Revenue Partners connects midwifery practices and birth centers with vetted medical billing experts who understand these differences. This page summarizes the services involved and the problems that most often affect midwifery billing and birth center billing.

Who this is for

• Certified nurse-midwife practices
• Independent and licensed midwives
• Freestanding birth centers
• Hospital-affiliated midwifery groups
• Practices that serve many Medicaid patients

What gets billed

• Prenatal visits
• Global maternity care
• Vaginal delivery, when midwifery delivers
• Postpartum visits
• Well-woman exams and family planning
• Contraceptive device insertion and removal
• Newborn care performed by the midwife where allowed
• Birth center facility services
• Lactation and education services where covered
• Telehealth prenatal and postpartum visits where payers allow

Commonly billed codes

Code	Type	What it covers
59400	CPT	Global care for a vaginal delivery
59409	CPT	Vaginal delivery only
59410	CPT	Vaginal delivery with postpartum care
59610	CPT	Global care for vaginal birth after a prior cesarean
59425	CPT	Antepartum care only, four to six visits
59426	CPT	Antepartum care only, seven or more visits
59430	CPT	Postpartum care only
58300	CPT	Placing an intrauterine device
99213	CPT	Established patient office visit, low complexity
Z34.00	ICD-10-CM	Supervision of a normal first pregnancy, unspecified trimester
Z39.2	ICD-10-CM	Routine postpartum follow-up

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in midwifery and birth centers

• Credentialing by midwife type. Payers may enroll nurse-midwives but not all other midwives. Billers check each plan's rules before accepting its patients.
• Medicaid state rules. Medicaid programs set their own coverage and payment for midwives and birth centers. Billers keep a current guide for each state the practice serves.
• Professional and facility billing. A birth center may submit separate claims for the professional service and the facility. Billers track both to avoid gaps.
• Transfer of care. If a patient transfers to a hospital during labor, billing changes. Billers split services based on who performed what and when.
• Supervision or collaboration rules. Some states require a collaborating physician, which can affect how claims are submitted. Billers confirm what each payer needs on the claim.
• Global versus itemized billing. Payers differ on when to use the global code. Billers count visits and follow plan policy.
• Self-pay and sliding scale clients. Many clients pay out of pocket. Clear estimates, receipts and superbills help clients seek reimbursement.

How Westmont can help

• Match your practice with vetted billing experts experienced in midwifery and birth centers
• End-to-end revenue cycle support, from verification to payment posting
• Denial management and appeals
• Credentialing and payer enrollment support
• Help organizing professional and facility billing

Frequently asked questions

Can midwives bill insurance directly?

Many can, but it depends on the midwife's license, the state and the payer. Nurse-midwives are widely credentialed. Other midwife types may face limits. Confirm each payer's enrollment rules before offering services to its members.

How do birth centers bill for facility costs?

Birth centers may bill a facility fee separately from the professional service, depending on payer and state. Medicaid programs often have their own methods. Confirm requirements with each payer and review them each year.

Does Medicaid cover midwifery care?

Many Medicaid programs cover midwifery and birth center care, but rules differ. Check your state's current provider manual and managed care plan policies.

What if a client transfers to the hospital?

Billing usually changes, since the hospital and a physician may take over delivery. Your biller should split the claim by services provided and follow payer policy on transferred care.

How do we support self-pay clients?

Provide a clear fee estimate, an itemized receipt and a superbill the client can submit to their plan. Policies on out-of-network reimbursement vary, so advise clients to check with their insurer.

Related billing services

• OB/GYN
• Maternal-Fetal Medicine
• Neonatology and NICU
• Pediatrics
• Ambulatory Billing