Physician practices who provide OB services often want to know if they can bill separately for the first OB visit, or if it is part of the global package.  The short answer is: once you begin the OB service, it is part of the package.

Prior to home pregnancy tests, many patients came in to see if they were pregnant.  Then, that first visit to confirm the pregnancy was a separate service.  Now, however, most patients know that they are pregnant prior to making the first OB appointment.  They are scheduled for the visit as a first OB visit. Once the nurse begins the OB documentation, that visit is included in the payment for the global service.

It would be incorrect to bill a high level E/M service for this visit.

Some state Medicaid programs require you to bill for each visit separately.  If so, follow their rules.