MaineCare TH Modifier and 2027 Maternity Billing Changes

MaineCare announced maternity billing changes effective September 1, 2026, in preparation for the AMA’s broader CPT maternity care revisions effective January 1, 2027. The AMA changes include the removal of 17 codes, addition of 12 codes, and revision of 6 codes. Pasted markdown

Now, MaineCare is moving maternity care toward non-global and non-bundled coding and reimbursement. Pasted markdown

MaineCare Maternity Billing Changes Effective September 1, 2026

Providers must transition applicable maternity visits from global or bundled service codes to appropriate Evaluation and Management (E/M) codes, based on the member’s estimated due date and anticipated remaining antepartum visits. Pasted markdown

TH Modifier Requirement

MaineCare requires providers to append the TH modifier to maternity care E/M service codes to identify the encounter as maternity care. Pasted markdown

Individual Encounter Documentation

Providers must move from total-visit tracking to individual encounter documentation. Each prenatal and postpartum visit must support the applicable E/M requirements based on complexity or time.

Maternity Diagnosis Coding

Providers should continue reporting applicable maternity-related diagnosis codes on MaineCare claims to support accurate maternity service reporting.

Preparing for January 1, 2027

As the first priority, OB/GYN practices should review the following before the broader AMA changes take effect

• E/M coding & maternity billing workflows
• TH modifier configuration
• Prenatal & postpartum documentation
• maternity-related diagnosis reporting
• EHR templates & claim edits;
• Staff training.

It is also necessary for providers to monitor MaineCare e-messages, AMA guidance, and professional guidance for additional updates.

BillingFreedom Support

BillingFreedom helps Maine OB/GYN practices translate MaineCare maternity billing requirements into clear documentation, E/M coding and TH modifier workflows. Our billing and coding team supports accurate claims today and prepares for the 2027 CPT transition. Contact BillingFreedom to review your OB/GYN billing process before the transition.

Resources

Maine.gov - STATE OF MAINE Department of Health and Human Services

2027 OB billing: MaineCare moves prenatal visits to E/M + TH by Sept 1, 2026 ahead of 2027 codes