Beginning January 1, 2027, a significant change will take place in how maternity care is documented and billed across the United States.
For decades, prenatal care, delivery, and postpartum care have largely been bundled together and reported to insurance companies as one service. Beginning in 2027, that global approach will be replaced by a new coding structure that reports the different phases of maternity care separately.
What will patients notice?
One of the biggest differences will be how often you see maternity services reported to your insurance company.
Under the current global model, many routine prenatal visits are included within one larger maternity package. Under the new system, prenatal visits will generally be submitted individually.
That means you may receive an Explanation of Benefits, or EOB, after each prenatal visit.
An EOB is not necessarily a bill. It is a statement from your insurance company showing the services that were submitted, what your insurance covered, and whether any amount may be your responsibility.
Seeing more individual services or charges listed does not necessarily mean your pregnancy is costing more.
Routine prenatal visits are not expected to suddenly result in additional patient charges simply because they are being reported individually. Services such as laboratory testing, ultrasounds, and other care may continue to have separate charges based on your individual insurance coverage, just as they do now.
The biggest difference for many patients may be when charges and payments occur rather than the overall cost of their maternity care.
What exactly is changing?
Currently, most maternity care is reported using what is known as a global maternity code.
The global maternity package allows many months of prenatal visits, the delivery, and postpartum care to be grouped together and submitted to an insurance company as one bundled service.
Beginning January 1, 2027, the national CPT coding structure will instead distinguish among four phases of maternity care:
● Antepartum or prenatal care: Prenatal visits will generally be reported individually.
● Labor management: Care provided while a patient is in labor before delivery will be reported separately.
● Delivery: The delivery itself, whether vaginal or cesarean, will have its own coding.
● Postpartum care: Follow up care after delivery will generally be reported individually.
Instead of one code representing much of a patient’s pregnancy, the new structure creates a more detailed record of the care provided from pregnancy through postpartum recovery.
Why is maternity billing changing?
The way maternity care is delivered has changed considerably since the global maternity model was developed.
Pregnancy care is not always provided by one physician in one location. A patient may receive routine prenatal care from one practice, see specialists during pregnancy, require additional monitoring, receive care through telehealth, transfer between facilities, deliver with a hospital based team, or receive postpartum care from another clinician.
Two patients may both have a baby, but the care required throughout their pregnancies can look very different.
The traditional global code does not always capture those differences. It can also make it difficult to identify which clinicians provided specific services, when additional care was required, or where complications occurred.
Recognizing these concerns, the American Medical Association, the American College of Obstetricians and Gynecologists, and other national medical specialty organizations spent nearly two years developing a more modern coding structure. The framework was approved through the AMA’s CPT process and takes effect January 1, 2027.
Why does reporting care separately matter?
Separating maternity care into individual services creates a more detailed picture of what happens throughout pregnancy, delivery, and postpartum care.
Every pregnancy is different. Some patients have routine prenatal care with minimal intervention. Others may need additional appointments, consultations, testing, monitoring, or coordination because of maternal or fetal health concerns.
Reporting those services separately can better reflect the time, medical decision making, coordination, and responsibility involved in caring for each patient.
The additional information may also help physicians, health systems, researchers, and policymakers better understand how maternity care is being delivered, where complications occur, and where opportunities exist to improve maternal health outcomes.
It also better reflects the increasingly individualized and team based nature of modern maternity care.
Will having a baby cost more?
The change in coding itself does not necessarily mean that your overall maternity care will become more expensive.
What may change is when you see charges and make payments.
Under the global model, many maternity services were grouped together. Under the new system, you may see individual services reported throughout your pregnancy and additional individual charges associated with labor, delivery, your hospital stay, and postpartum care.
Those charges may look different because the global charge they were previously part of will no longer exist.
Your existing insurance benefits do not change because of the new coding system. Your deductible, copays, coinsurance, network requirements, and covered benefits will continue to be determined by your individual health plan.
Because every insurance plan is different, we encourage patients with questions about their specific coverage or financial responsibility to contact their insurance company.
What if I am pregnant in 2026?
The new maternity care coding changes are scheduled to take effect January 1, 2027. However, insurance companies and healthcare organizations are still determining how these changes will be implemented.
If you are pregnant in 2026 with a due date in 2027, you may notice changes to the way your prenatal visits, delivery and postpartum care are reflected on insurance statements or bills. Exactly what those changes will look like may vary depending on your insurance plan, and many details are still being finalized.
OGA Women’s Health is closely following these updates and will share additional information as it becomes available.
For the latest information, please continue to check our website and follow OGA Women’s Health on social media.
We are here for you.
As we approach 2027, OGA Women’s Health is continuing to work with insurance companies and our billing partners as new information becomes available. Because many details are still being finalized, we will make changes as needed and share updates with our patients as quickly as we can.
For most patients, there is nothing you need to do differently right now. Continue attending your scheduled prenatal appointments and make sure OGA Women’s Health has your current insurance information.
If you receive an EOB or patient statement that you do not understand, please contact our billing team. We are happy to help explain how your maternity services were billed and how your insurance company processed them.
Questions about hospital charges should be directed to St. Luke’s. Questions about your individual insurance benefits, deductible, copays or coinsurance should be directed to your insurance company.
As this transition continues to develop, we will keep patients informed through the OGA Women’s Health website and social media channels. Our priority remains the same: providing safe, individualized, high-quality care throughout pregnancy, delivery and the postpartum period.
Sources: American Medical Association, CPT 2027 Maternity Care Services Code Changes and FAQs: CPT 2027 Maternity Care Services Code Changes
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