AMA Finalizes 2027 Maternity Care CPT Changes

The AMA has already stated that the traditional maternity global structure will be replaced by phase-specific billing. Significant changes in the CPT have been approved by the American Medical Association and will impact maternity care billing starting January 1, 2027.

AMA 2027 Maternity CPT Structure

The 2027 CPT update introduces new service phases of maternity care, which eliminates multiple old, global maternity codes.

New Phase-Specific Code Structure

• Antepartum encounters: individual E/M codes
• Labor management: new codes 59080 to 59083
• Vaginal delivery: 59431 and 59432
• Cesarean delivery: 59502 and 59503
• Third- and fourth-degree repairs: 59433 and 59434
• Cesarean hysterectomy: 59504
• Postpartum hemorrhage uterine tamponade: 59623
• Postpartum care after delivery day: appropriate inpatient or outpatient E/M codes

Codes Being Deleted

Seventeen existing codes, including 59400, 59425, 59426, 59430, 59510 and the 59610/59618 global families, will be invalid for dates of service beginning January 1, 2027. See the AMA code-change overview for the complete list.

Billing Pregnancies That Cross the Year

• Four or more 2026 antepartum visits remain reportable with 59425 or 59426.
• Three or fewer 2026 visits use individual E/M codes.
• Every antepartum encounter occurring in 2027 uses an appropriate E/M code.
• Deleted global codes should be rejected for 2027 dates of service.

Clarification on Medical Decision Making

The AMA also clarified that normal pregnancy can qualify as a moderate problem addressed for the Problems Addressed component of MDM. This does not automatically support a level-four visit; the other MDM elements or documented total time must still support the selected code. Details are in the AMA's detailed 2027 maternity FAQ.

Revisions to CPT Code Descriptors and Guidelines

The maternity coding update includes revisions to CPT® code descriptors and guidelines. In total, 17 codes were deleted, 12 codes were added, and six codes were revised. The changes also introduce new subsections, revise existing guidelines, and relocate some existing codes.

Antepartum Care

Antepartum care includes all evaluation and management (E/M) care provided to the patient and/or fetus(es) before the onset of labor.

All current antepartum care codes will be deleted and reported per encounter using an E/M code. The current E/M rules will therefore apply to these services as well.

The updated approach also facilitates real-world reporting of E/M services based on the patient's location, including:

• Office
• Hospital
• Telemedicine

Labor Management

Labor management will be reported once per calendar date. New codes have been created for both Initial Day and Subsequent Days, with each further divided into two levels:

• Straightforward (SF)
• Complex

For facility reporting, the Initial Day code is reported once per facility admission unless there is a unique provider.

The reporting approach is similar to existing guidelines for inpatient hospital care.

Delivery

The new maternity coding framework includes new, streamlined codes for vaginal and cesarean deliveries, such as: 

• Vaginal deliveries with and without episiotomy
• Vaginal birth after cesarean (VBAC)
• Primary cesarean deliveries
• Repeat cesarean deliveries

These codes only use delivery care and are not dependent on other maternity care components. Labor management is not included in the report. 

The update also introduces distinct codes for:

• Third-degree laceration or episiotomy repair
• Fourth-degree laceration or episiotomy repair
• Hysterectomy following cesarean delivery as a stand-alone code

Postpartum Care

All current postpartum care codes will be deleted and reported per encounter using E/M codes in 2027. The current E/M rules will apply to these services.

Routine postpartum care performed on the same calendar day as delivery is incorporated into the delivery care code.

For facility births, subsequent hospital care codes will be reported for each management day after the delivery day until discharge.

A new, distinct procedure code has also been added for uterine tamponade.

Impacted CPT 2027 Maternity Codes

The CPT 2027 code set includes deleted, new, and revised codes for maternity care services, effective January 1, 2027. The impacted codes are organized below by category.

Deleted CPT Maternity Codes

The following 17 codes are scheduled for deletion:

• 59050
• 59400
• 59409
• 59410
• 59425
• 59426
• 59430
• 59510
• 59514
• 59515
• 59525
• 59610
• 59612
• 59614
• 59618
• 59620
• 59622

New CPT Maternity Codes

The following 12 new codes are included in the CPT 2027 maternity care code set:

• 59080
• 59081
• 59082
• 59083
• 59431
• 59432
• 59433
• 59434
• 59502
• 59503
• 59504
• 59623

Revised CPT Maternity Codes

The following six codes have been revised:

• 59412
• 59051
• 59414
• 59300
• 59898
• 59899

Together, these changes include 17 deleted codes, 12 new codes, and six revised codes within the CPT 2027 maternity care coding framework.

Handling the 2026–2027 Transition in Antepartum Billing

It is important to note that the change from global obstetric reporting to E/M by encounter does not change the fact that care provided that spanned both 2026 and 2027 was not one billing period of care. When the antepartum services occur in both calendar years, you must change the reporting rules for the CPT applicable to the encounter based on the calendar year that the encounter is documented. 

When Antepartum Care Begins in 2026 and Continues Into 2027

Imagine an antepartum visit for five visits in 2026 and continuing antepartum visits in 2027 before delivery.

The five antepartum visits in 2026 are reported in the 2026 structure. The code for four or more antepartum visits for that calendar year would be 59425 (4-6 visits).

If the patient had received only three or fewer antepartum visits during 2026, each encounter would instead be reported separately using the appropriate E/M code.

The 2027 antepartum encounters would then be reported individually using the E/M code appropriate for each service provided. The 2027 encounters would not be combined with the 2026 antepartum reporting.

What This Means for OBGYN Billing Teams

If the pregnancy extends beyond 2026-2027, billing teams should split the encounters based on calendar year and use the respective CPT reporting framework. In the above example, the 59425 would be used to report the 5 qualifying antepartum visits in 2026 and each applicable antepartum visit visit in 2027 would be reported with its appropriate E/M code. 

Additionally, practices should confirm reporting/reimbursement policies with each third party payer of which the policy may apply to a pregnancy that extends across 2 years to avoid any payer specific transition requirements. 

Applying the 2026 Reporting Rules

The new maternity reporting framework does not begin to apply to antepartum services because the patient's pregnancy extends into 2027, although the patient may be pregnant in 2026 and deliver after January 1, 2027. CPT reporting guidelines in 2026 will apply to services provided during the 2026 calendar year. 

When E/M Codes Apply in 2026

Each antepartum visit (1-3) during Calendar Year 2026 should be coded as one encounter with the E/M code for one of those visits. The antepartum care reporting structure continues to apply to all antepartum visits 2026 except 4 or more antepartum visits. 

When the E/M-Only Approach Begins

The transition to reporting all antepartum encounters with the appropriate E/M codes begins for services provided on or after January 1, 2027. A pregnancy with a 2027 delivery date therefore does not, by itself, require E/M reporting for all antepartum activity performed during 2026.

Payer Transition Requirements

Alongside the CPT reporting rules, providers should review the policies of their third-party payers. Payers may establish additional requirements for reporting antepartum services during the transition from the 2026 to 2027 framework.

Prenatal Billing When the Due Date Falls in 2027

It is not a rule that a 2027 due date will permit a practice to code 2026 prenatal visits as E/M coding. Antepartum services for 2026 will continue to be reported as an E/M service only if the count of the routine antepartum encounters for 2026 is 3 or fewer. 

Determining When to Submit the Claim

Practices could choose to hold off on claiming the 2026 calendar year routine antepartum until the completed number of routine antepartum encounters (ROA) is reasonably assured. This can minimize the number of amended claims submitted if the number of visits changes close to the end of the year, and generally help keep the practice within the allowed 90-day timely filing window, providing routine antepartum visits are no more than one month apart. 

E/M Documentation for 2027 Deliveries

For patients with due dates on or after January 1, 2027, documentation for each prenatal encounter should support the E/M requirements, including the applicable medical decision making and/or time needed to select the appropriate E/M code when required.

Reporting Based on the 2026 Encounter Count

The reporting approach can be organized around the number of completed routine encounters:

• 1–2 routine encounters: Submit the claim after the final encounter.
• 3 routine encounters: Submit the claim after the third encounter.
• 4–6 routine encounters: Report 59425 (Antepartum care only; 4–6 visits) after the final encounter.

Separating Non-Routine Antepartum Encounters

Non-routine encounters during the antepartum period are not included in the routine encounter count above. These services should be evaluated and reported separately based on the nature of the encounter.

Reporting 2026 Antepartum Services Before a 2027 Delivery

For patients who are expected to deliver in 2027, 2026 antepartum services do not need to remain unbilled until the delivery occurs. The 2026 antepartum services can be coded and submitted at the end of 2026 or early in 2027 based on the applicable reporting requirements.

Applying the 2026 Visit Count at Year-End

The number of routine antepartum visits completed during 2026 is relevant for the time of reporting antepartum care at the end of 2026. 

• Three or fewer visits: Report each encounter with the appropriate E/M service.
• Four to six visits: Report 59425 for antepartum care only.
• Seven or more visits: Report 59426 for antepartum care only.

This allows the 2026 services to be reported according to the applicable 2026 CPT framework even when the patient's delivery will occur in 2027.

Selecting ICD-10-CM Codes for Routine Prenatal Care in 2027

The transition in CPT maternity reporting does not change the existing ICD-10-CM rules for selecting pregnancy-related diagnoses. For routine outpatient prenatal visits where no complication or other obstetric problem is present, the applicable Z34.- code is reported as the first-listed diagnosis.

A Z34.- code should not be reported together with a Chapter 15 obstetric code from O00–O9A. When additional information about the pregnancy is needed, a Z3A.- code may be assigned to identify the weeks of gestation.

Distinguishing Routine and Complicated Prenatal Encounters

Diagnosis selection will be based on the type of encounter (routine or obstetric problem or complication). Z34.- is reserved for pregnancy encounters in which there is no Chapter 15 problem/complication. 

For routine outpatient prenatal care, the Z34.- code remains first-listed and should not be combined with another Chapter 15 code. Z3A.- may provide supplemental gestational-age information when applicable.

Z3A.- Reporting Considerations

Weeks-of-gestation codes in category Z3A can provide additional pregnancy information, but they are not assigned in every pregnancy-related circumstance. They should not be used for pregnancies with abortive outcomes in categories O00–O08, elective termination of pregnancy reported with Z33.2, or postpartum conditions where gestational-age reporting is not applicable.

Labor Management That Crosses December 31 and January 1

Let's take a patient who is admitted on 31st December 2026 and delivers on 1st January 2027. The reporting will be based on whether the labour management delivered between the two dates constitutes a continuous service. 

If the physician or other qualified healthcare professional is giving continuous, personal care attention to the same patient and covering both calendar dates, then the entire care is a single service. In that case, the relevant initial labor management code (2027) for the first time should be reported on January 1. 

• 59080 - straightforward labor management
• 59081 - complex labor management

If the labor management does not meet the requirements for a continuous visit, the December 31 service may instead be reported using an initial hospital inpatient or observation E/M code (99221–99223). These E/M codes may be selected using either medical decision making or total time on the date of service.

Because this represents an uncommon transition scenario, providers should also verify whether their payer has additional requirements for reporting services across the 2026–2027 boundary.

Delivery in 2026 With Postpartum Care in 2027

If the delivery is made in November or December 2026, then the postpartum care is provided for 2027. Because the delivery was under the 2026 reporting framework, a global maternity code, if applicable, based on the method of delivery may be reported at that time, e.g. 59400. 

Then the appropriate E/M code can be used to report postpartum services starting from January 1, 2027. As the postpartum care period is extended to 2027, the reporting framework for the 2026 delivery is not changed. 

How Antepartum Care Will Be Reported in 2027

The 2027 maternity coding structure changes how antepartum services are reported. Instead of grouping eligible prenatal care under the previous antepartum-only structure, each encounter will be evaluated and reported according to the service provided.

Report Each Antepartum Encounter Separately

Antepartum care will be reported using the appropriate E/M service for each encounter. The patient's location and the setting in which care is provided—such as an office, hospital, or telehealth encounter—will help determine the applicable E/M service.

Standard E/M reporting rules will apply, with code selection based on Medical Decision Making (MDM) or time.

Account for Nonphysician QHP Services

Not every qualified healthcare professional may report E/M services. When antepartum care is provided by a nonphysician QHP who does not report E/M services, the specific service performed should be considered for reporting, such as genetic counseling or medical nutrition therapy.

Antepartum and fetal invasive procedure codes continue to apply, with some services relocated within the CPT structure.

Apply the Correct Date for 59425 and 59426

For the 2026 reporting structure, when 59425 or 59426 is used for antepartum care only, the code is reported after the number of visits represented by the code has been completed.

The date of service should be the date of the last antepartum visit(s) included in the reported code. However, there may be differences in the requirements for the payers. The last encounter date may be requested by some payers, and a first and last service date range may be required by some payers when supporting documentation is submitted.

Identify Maternity-Related Claims Through Diagnosis and Modifier Use

Encounters related to pregnancy are identified by pregnancy-related codes in the ICD-10-CM, such as the Chapter 15 O codes or the ICD-10-CM pregnancy codes (Z34.-). Modifier TH is also used to specify obstetrical treatment or services rendered during the prenatal or postpartum diagnosis or treatment period, when applicable. 

E/M Intensity Can Differ Between Antepartum Encounters

The 2027 structure does not assign one fixed E/M complexity level to a patient throughout the entire antepartum period. Each prenatal encounter must be evaluated independently based on the service provided on that date.

The appropriate E/M level can be determined using total time on the date of the encounter or Medical Decision Making (MDM). As a result, the intensity and resulting E/M code may vary from one antepartum visit to another

FAQs Related To Preparing for Maternity Care Code Changes 

Where Can Providers Review the 2027 Maternity Codes?

The AMA has released the new, revised, and deleted maternity care codes and guidelines ahead of the 2027 implementation date. Providers and billing teams should review the published guidance while preparing for the transition and use the final CPT 2027 Professional Edition for the definitive code language once available.

When Will Payment Values Be Finalized?

The AMA/Specialty Society RVS Update Committee submitted its recommendations to CMS in February 2026. CMS subsequently included proposed relative values for the maternity services in its Medicare Physician Payment Schedule Proposed Rule issued July 14, 2026.

The CMS Final Rule is expected in early November, with implementation beginning January 1, 2027. The submitted recommendations were anticipated to remain budget neutral.

What Should Health Plans and Billing Teams Prepare for Now?

It is recommended that preparation be started prior to the 2027 effective date. Organizations should check for any contracts or fee schedules that still include the canceled global maternity codes, make any necessary billing changes, systemize any changes with vendors and plan for various transition scenarios. 

Teams should also account for applicable state-specific requirements and prepare for more detailed claims data across the individual maternity care phases.

How Will Claims Editing Apply to Different Code Combinations?

The revised CPT guidelines will guide claims editing for code combinations that may be appropriate together, inappropriate together, or valid only in particular clinical circumstances.

For example, a labor management service and a delivery service may be reported on the same date when supported by the applicable guidelines. In contrast, reporting both straightforward and complex labor management for the same physician and date would not represent an appropriate combination. Other combinations may require review of the specific clinical circumstances before determining whether the reported services are appropriate.

How Can Phase-Based Reporting Support Care Management?

Reporting maternity services by phase creates more detailed visibility into the care delivered during pregnancy, labor, delivery, and postpartum periods. More frequent E/M reporting and diagnosis information can provide additional data related to medical complexity and other pregnancy-related risk indicators.

This information can support identification of patients who may benefit from timely outreach, care management, and other interventions while also improving the ability to track maternal and infant outcomes.

Can Deleted Global Codes Be Reported for 2027 Dates of Service?

No. Deleted CPT codes are invalid for dates of service beginning January 1, 2027. Billing systems and clearinghouses should therefore be configured to prevent those codes from being submitted for 2027 services.

OB/GYN billing teams will need to transition affected claims to the applicable phase-specific maternity codes and E/M services.

2027 Vaginal and Cesarean Delivery Coding FAQs

How Is Vaginal Delivery Reported in 2027?

Two new CPT codes will be used for vaginal delivery:

• 59431 - Vaginal delivery, with or without episiotomy
• 59432 - Vaginal delivery, with or without episiotomy; after previous cesarean delivery

The delivery codes include delivery of the placenta, repair of first- or second-degree lacerations performed by the delivering physician or other QHP or their group, and routine postpartum care provided on the same day as delivery.

How Is Cesarean Delivery Reported in 2027?

The two new codes to be used for cesarean deliveries are:

• 59502 - Cesarean delivery; primary
• 59503 - Cesarean delivery; repeat

The incision, delivery, placenta, and closure are included in each code. Occasionally, the cesarean delivery code is used more than 1 time for the same delivery event (as the number of fetuses may vary).

When labor management is also provided, it may be reported separately when applicable. Examples include failed labor before a primary cesarean or a trial of labor after cesarean (TOLAC) before a repeat cesarean.

How Will VBACs Be Coded in 2027?

For a vaginal birth after cesarean (VBAC), report 59432, which specifically applies to vaginal delivery following a previous cesarean delivery.

If a patient undergoes a cesarean delivery after attempting a VBAC, the delivery is reported with 59503 (Cesarean delivery; repeat) because the patient has a previous cesarean delivery.

If the patient has only had previous vaginal deliveries and now requires a cesarean, report 59502 (Cesarean delivery; primary).

Can Labor Management Be Reported Separately From Delivery?

Yes. When labor management is performed, it is reported in addition to the applicable delivery service.

For a patient with a previous cesarean who is attempting a VBAC, the labor management qualifies as complex labor management under the 2027 maternity care reporting structure.

 

How Does BillingFreedom Support the 2027 CPT Transition?

The 2027 maternity CPT restructuring changes how OBGYN services move through the billing cycle. BillingFreedom uses OBGYN medical billing workflows to separate service phases, identify cross-year encounters, and apply payer-specific claim checks before submission.

Rebuild Maternity Billing Workflows

BillingFreedom can transform current global labor, delivery, and antepartum workflows around each individual service. This will help mitigate legacy logic from global-code having to seep into the claim submission process for 2027. 

Control Cross-Year Pregnancy Claims

Legacy and 2027 billing scenarios can be in a pregnancy that starts in 2026. BillingFreedom can review service dates and antepartum visit history to decide on the billing model for each encounter, rather than having a single service date for the entire pregnancy. 

Add Pre-Submission CPT Validation

Billing teams can set up claim edits to identify codes that have been deleted from the claim, inappropriate E/M coding, and services that are not covered by the CPT rules. These checks provide a quality control process with yet another quality control point before claims are received by the payer. 

Strengthen E/M Documentation Review

Because the 2027 structure relies more heavily on individual E/M reporting, BillingFreedom can review documentation for code-level support, including MDM and total-time requirements. Normal pregnancy can be considered within the Problems Addressed element, but the complete E/M requirements still need to support the reported level.

In the case of an OB/GYN practice, the 2027 transition demands a billing strategy that aligns with the CPT changes, documentation, tracking encounter data, claim edits, and payer-specific requirements. By streamlining billing for its OB/GYN medical billing support, BillingFreedom ensures that practices have the flexibility to implement those changes and minimize unnecessary coding and submission mistakes.

To learn more about our outstanding medical billing services, you may not hesitate to get in touch with us through email at info@billingfreedom.com or by phone at +1 (855) 415-3472. 

Our priority is your financial peace of mind!