Billing Maternity Care That Spans 2026 and 2027 — redline

Maternity billing gets more complicated when prenatal care starts in 2026 and continues into 2027. With the CPT maternity coding changes taking effect January 1, 2027, OB/GYN practices must account for services provided on either side of the transition.

The number of routine prenatal visits completed in 2026 determines how to report antepartum care. Practices should keep records of each visit, review services before submitting claims, and follow payer-specific transition guidelines. The expected delivery date alone shouldn't determine which codes to use.

What Changes Under the 2027 Maternity Structure?

Beginning January 1, 2027, the CPT framework moves away from traditional global maternity coding. Instead, maternity care is divided into four separately reported phases:

• Antepartum care: Prenatal visits billed using the appropriate evaluation and management (E/M) codes.
• Labor management: Separate codes based on the initial or subsequent day of labor management and whether care is straightforward or complex.
• Delivery: Procedure codes based on vaginal or cesarean delivery.
• Postpartum care: E/M codes for qualifying visits after the delivery date. Routine care provided on the delivery date remains part of the delivery service.

The AMA’s maternity coding overview explains the revised CPT structure.

However, adopting new CPT codes doesn’t mean every insurance plan will follow the same billing or payment policy. Practices should review payer requirements before changing their claims.

Reporting Prenatal Visits Completed in 2026

For pregnancies that continue into 2027, count the routine antepartum visits your practice completed during 2026.

That count determines whether to bill the visits individually or report them using an antepartum-only code.

Routine visits completed in 2026	How to report them
1–3 visits	Bill each qualifying visit with the appropriate E/M code
4–6 visits	Report CPT 59425 for antepartum care only
7 or more visits	Report CPT 59426 for antepartum care only

Count only prenatal visits that have taken place, leaving out scheduled or future appointments. Antepartum-only codes don’t cover delivery or postpartum services. Make sure the same prenatal care isn’t billed under both an antepartum-only code and a global maternity claim. The AMA’s antepartum transition reporting brief provides more information.

Do Practices Have to Wait Until December 31 to Submit Claims?

Not necessarily.

Under the AMA’s transition guidance, practices may finalize reporting for 2026 antepartum care at year-end or in early 2027. They don’t have to wait until the patient delivers.

The important part is knowing how many qualifying routine visits were completed during 2026.

Keep a record of each visit as it happens and review the final count before submitting the claim. A transfer of care or an earlier-than-expected delivery can affect which code is appropriate.

Also check the payer’s filing deadlines and submission instructions. AMA coding guidance doesn’t replace individual insurance plan requirements.

How to Bill Maternity Services Beginning January 1, 2027

Report prenatal visits provided in 2027 individually using the appropriate E/M codes.

The E/M level depends on the service provided, care setting, and applicable medical decision-making or time requirements. Practices shouldn’t assign the same code to every routine prenatal visit without reviewing the documentation.

The AMA’s antepartum care FAQs explain how to approach these visits.

For delivery services, the 2027 CPT structure includes the following codes:

Delivery service	2027 CPT code
Vaginal delivery	59431
Vaginal birth after a previous cesarean	59432
First cesarean delivery	59502
Repeat cesarean delivery	59503

Labor management may be reported separately when the service meets CPT requirements. For a planned cesarean performed before labor begins, a labor management code wouldn’t apply.

Report postpartum visits after the delivery date using the appropriate E/M codes.

Before updating charge templates or billing software, review the AMA’s maternity codes and guidelines.

What About Placenta Delivery and Perineal Repairs?

Not every service performed during delivery can be billed separately.

Placenta delivery and first- or second-degree repairs are included in vaginal delivery care when the delivering clinician or another clinician within the same specialty or subspecialty group performs them.

Higher-degree repairs and services performed by other clinicians may require a different coding approach. Review the applicable CPT instructions before adding separate charges. A separately reportable service doesn’t automatically qualify for separate reimbursement.

Examples of Maternity Care Crossing the 2026–2027 Transition

The following two scenarios show how the reporting rules apply when services occur in different calendar years.

December 2026 Delivery With January 2027 Postpartum Care

An OB/GYN practice provides the patient’s qualifying global maternity care, including a vaginal delivery on December 18, 2026.

The patient returns for a postpartum office visit on January 29, 2027.

Under AMA transition guidance, the practice may report the appropriate 2026 global maternity code, such as 59400, along with an applicable E/M code for the postpartum service provided in 2027.

Confirm payer processing and payment rules before applying this example. A payer may require a different transition billing approach or treat postpartum care as included in its global reimbursement.

Prenatal Visits in 2026 With Delivery in February 2027

A patient completes eight qualifying routine prenatal visits during 2026 and continues receiving care from the same practice in 2027.

The patient delivers in February 2027.

For the eight completed routine visits in 2026, the practice reports CPT 59426 under AMA guidance.

Report subsequent prenatal encounters with E/M codes and the 2027 labor, delivery, and postpartum services under their applicable rules.

The practice should also check that none of the 2026 visits were already included in another claim.

The AMA’s maternity transition FAQ covers both scenarios. Confirm the patient’s coverage and payer requirements before applying either approach.

Frequently Asked Questions

Do Non-Routine Prenatal Visits Count Toward CPT 59425 or 59426?

No. Non-routine antepartum encounters aren’t included when determining the number of routine visits for CPT 59425 or 59426.

Review those visits separately and assign the appropriate codes based on the documented services and payer requirements. See the AMA’s transition guidance.

What Service Date Should Be Used for a 2026 Antepartum-Only Claim?

According to the AMA’s antepartum care guidance, the reported service date is the last prenatal encounter included in the antepartum-only code.

Some insurers may request a date range or additional records. Check the payer’s claim instructions before submission.

What does this mean for your practice as you Prepare Your OB/GYN Practice for the Transition?

OB/GYN billing teams should review pregnancies continuing into 2027, especially when prenatal visits occur in 2026, and delivery or postpartum care occurs the following year.

The following steps can help prevent coding errors and overlapping charges:

• Review 2026 prenatal visits. Keep a dated record of completed routine encounters for each pregnancy. Use E/M codes for 1–3 visits, CPT 59425 for 4–6 visits, or CPT 59426 for seven or more, as applicable.
• Check the visit count. Count only completed routine prenatal visits. Leave out missed appointments, future visits, and non-routine care before submitting antepartum-only claims.
• Check Payer Rules & Deadlines. Review service-date requirements, filing deadlines, and transition instructions from commercial insurers and Medicaid programs.
• Update EHR & Billing Templates. Prepare your EHR and practice management system for individual prenatal and postpartum E/M reporting beginning January 1, 2027.
• Review care that crosses year-end. Pay particular attention to December deliveries, January postpartum visits, and labor that extends across December 31 and January 1.
• Look for duplicate charges. Compare existing global, antepartum-only, and individual encounter claims before submitting additional services.

Need Help Preparing Your Maternity Claims for 2027?

Changes to maternity coding can affect how OB/GYN practices record visits, prepare claims, and follow up on payments.

From reviewing prenatal visit records to identifying coding inconsistencies, BillingFreedom’s team provides expert OB/GYN medical billing services to practices across the nation. We prepare your maternity claims according to the billing requirements so you can focus on patient care.

Get in touch with a business associate today for a full review of your maternity billing workflow as you prepare for the 2027 transition.

Resources

• AMA: Antepartum Transition Reporting Education Brief.
• AMA: Maternity Care Spanning the Transition Date.
• AMA: Antepartum Care FAQs.
• AMA: CPT 2027 Maternity Codes and Guidelines