Anthem Nevada's Maternity Services Reimbursement Policy Update for 2027

The AMA has restructured CPT maternity coding effective January 1, 2027 . The proposed approach deviates from the current global maternity care structure by separating reporting of antepartum care, labor management, delivery, and postpartum care.

Anthem Blue Cross and Blue Shield Nevada has told providers how its Maternity Services – Professional reimbursement policy will follow that change, and that the final approach depends on whether CMS adopts the proposed HCPCS G-codes that would preserve a global-style option for Medicare. 

Understanding these potential changes will help providers follow the applicable reporting and reimbursement requirements as the 2027 effective date approaches. 

Two Possible Directions for Anthem's 2027 Maternity Policy

Effective January 1, 2027, the maternity services reimbursement policy will depend on whether CMS adopts the proposed HCPCS G-codes. Anthem will follow one of two approaches based on that decision.

If CMS Adopts the Proposed G-Codes

If CMS adopts the proposed G-codes, Anthem’s existing Maternity Services - Professional reimbursement policy will be updated to include the new CMS G-codes. Providers will be notified of any resulting updates to the reimbursement policy.

If CMS Does Not Adopt the Proposed G-Codes

If CMS does not adopt the proposed G-codes, Anthem’s Maternity Services - Professional reimbursement policy will incorporate the new AMA CPT maternity coding guidance beginning January 1, 2027. Under this approach, maternity services will be reported separately based on the specific maternity care provided rather than using the existing global maternity care codes.

New Coding Rules for Maternity Services will be effective January 1, 2027.

Effective dates of service on or after aforesaid dates, Anthem will revise its Maternity Services with Professional reimbursement policy to include the new AMA maternity coding structure.

Separate Reporting for Maternity Services

Maternity services will no longer be reported using the existing global maternity care codes. Instead, services must be reported separately according to the specific maternity care provided, including antepartum, delivery, or postpartum care.

Reporting of Antepartum and Postpartum Visits

Antepartum and postpartum visits are reported on a per visit basis with the appropriate evaluation and management code. If applicable, modifier TH will be necessary.

Reimbursement Frequency Limits for Routine Pregnancies

Routine pregnancies are subject to reimbursement frequency limits on antepartum and postpartum visits . These limits do not restrict clinically appropriate maternity care.

The antepartum limit does not apply to services associated with a documented high-risk pregnancy or active pregnancy-related complication. The postpartum limit does not apply to services associated with a pregnancy-related or postpartum complication.

Same-Day and Duplicative Maternity Services

Services that are part of the same maternity visit, or that represent duplicative work performed on the same date of service, may not be separately reimbursable.

Impact on Provider Billing Requirements

The policy change impacts care provider billing requirements. It does not impact member care or services. This policy change eliminates the ability for participating care providers to balance bill members.

What This Means for Your Practice

• Nothing changes on Anthem Nevada claims before January 1, 2027. Keep billing global maternity codes for deliveries through December 31.
• Watch for CMS's CY2027 Physician Fee Schedule final rule, expected in the first days of November. It decides which of Anthem's two policies you will be working under.
• Pull the current Maternity Services – Professional policy and find the antepartum and postpartum frequency limits. They are not in the notice, and they are what will drive denials.
• Flag documented high-risk pregnancies and active pregnancy-related complications in the chart now. Those are what take a visit outside the frequency limit.
• If you bill Anthem outside Nevada, the same notice went to nine other states. Check each market's reimbursement policy page.

Preparing for the January 1, 2027 Effective Date

As January 1, 2027 approaches, OBGYN healthcare service providers should review which maternity coding and reimbursement approach applies based on CMS’s decision regarding the proposed G-codes with the help of BillingFreedom’s expert team. If CMS adopts the proposed G-codes, Anthem will update its policy accordingly. 

If CMS does not adopt them, the AMA maternity coding structure will apply as outlined in the policy update. Staying current with the applicable reimbursement policy will be important as maternity reporting requirements change. 

BillingFreedom brings together a team of OBGYN medical billing and coding experts who stay current with evolving payer requirements, making it a relevant choice for providers seeking knowledgeable billing and coding support.