Michigan Medicaid Proposed 2027 OB Reimbursement Policy

This guideline explains updated coverage and billing requirements for routine maternity care services in Michigan Medicaid, including key coding changes effective January 1, 2027.

These updates align state Medicaid policy with coding changes established by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel.

1. Key Policy Changes & Effective Dates

Deletion of Global CPT Codes (Effective January 1, 2027)

The AMA CPT Editorial Panel is deleting global maternity care CPT codes representing bundled antepartum, labor and delivery, and postpartum care (e.g., 59400, 59510, 59620). Providers must transition to reporting separate CPT codes per encounter.

• Itemized Encounter Reporting:
  • Routine maternity services must be reported per encounter using the appropriate Evaluation and Management (E/M) or applicable CPT code(s) describing the specific services rendered based on patient location.
• Grace Period / Cutoff Date:
  • Claims submitted using global maternity care CPT codes on or after January 1, 2027, will be eligible for payment only if all dates of service occurred on or before December 31, 2026.

2. Claim Submission & Enhanced Reimbursement Criteria

To qualify for enhanced reimbursement rates under MSA 14-32 and the Practitioner Reimbursement Appendix, providers must meet the following billing requirements:

1. E/M Coding: Report the appropriate E/M or other applicable CPT code(s) in accordance with current AMA guidelines.
2. Modifier Requirements: Append Modifier TH to routine antepartum and postpartum E/M CPT codes to indicate routine care.
3. ICD-10-CM Diagnosis Coding: Append appropriate obstetric ICD-10-CM diagnosis code(s).
4. Documentation Standards: Clinical documentation must support Medical Decision Making (MDM) or time consistent with current CPT guidelines.

3. Service Stage Guidelines

Antepartum Care

• Antepartum care includes E/M services provided to the pregnant patient and/or fetus before labor begins.
• Providers should report the appropriate ICD-10-CM diagnosis code for each encounter.
• Modifier TH must be added to routine antepartum E/M claims.
• A code from ICD-10-CM category Z3A may also be reported when appropriate to identify the patient's weeks of gestation.
• Michigan Medicaid's enhanced reimbursement methodology will cover up to 13 antepartum E/M visits per pregnancy.
• If the patient requires more than 13 antepartum visits, additional visits may still be covered, but Michigan Medicaid will pay them using its normal physician-service payment methodology rather than the enhanced maternity rate.
• Separate procedures performed during the same visit, such as diagnostic testing, may also be covered when they are medically appropriate and billed according to correct coding rules.

Labor Management

• Report labor management using the appropriate ICD-10-CM diagnosis codes.
• A Z3A diagnosis code may also be reported when appropriate to identify the patient's weeks of gestation.
• Labor management may generally be reported once per calendar date.
• It should not normally be reported on the same day as hospital care codes when the same provider provides those services.
• Providers should follow current CPT and Michigan Medicaid billing rules when determining whether services may be billed separately.

Delivery Care

• Delivery care begins after labor management is complete and is inclusive  of same day routine postpartum. 
• Providers should report the appropriate CPT code and ICD-10-CM diagnosis codes for the delivery.
• Report a Z3A code, when appropriate, to document weeks of gestation.
• Providers may bill delivery care on the same day as initial or subsequent labor management when the same provider performs both services and coding requirements are met.
• For multiple gestation pregnancies involving a cesarean delivery, Michigan Medicaid generally covers the cesarean delivery once, regardless of the number of fetuses delivered.
• However, when one fetus is delivered vaginally, and a subsequent fetus requires a cesarean delivery, Michigan Medicaid covers the cesarean delivery in addition to the vaginal delivery.

Postpartum Care

• Report routine postpartum care using the appropriate postpartum ICD-10-CM diagnosis codes.
• Add modifier TH to routine postpartum E/M services when required.
• Michigan Medicaid's enhanced reimbursement methodology covers up to two postpartum E/M visits per pregnancy when those visits occur within 12 weeks after delivery.
• If additional postpartum visits are needed, they may still be covered, but they will be reimbursed under the regular physician-service payment methodology.
• Routine postpartum care is not separately reimbursable when it is reported on the same calendar day as the delivery because routine same-day postpartum care is considered part of the delivery service.

4. Clinic Settings (FQHC, RHC, THC, Tribal FQHC)

Clinic-Based Services

Deletion of Global Clinic CPT Codes: Effective January 1, 2027, global clinic maternity codes (e.g., 59425, 59426, 59430) are deleted.

Billing Structure: Antepartum and postpartum services provided in clinic settings on or after January 1, 2027, must be reported with:

1. Appropriate E/M CPT code
2. Clinic qualifying visit payment code
3. ICD-10-CM diagnosis code(s)
4. Modifier TH

Hospital & Non-Clinic Settings

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Tribal Health Centers (THCs), and Tribal FQHCs billing for eligible labor management and delivery care furnished outside the clinic (e.g., hospital settings) must follow these rules:

1. Claim Form: Submit separately on a professional claim form (CMS-1500 / 837P).
2. Billing Provider: Use an Organization/Group – Type 2 non-clinic specialty-enrolled NPI.
3. Rendering Provider: Use an eligible Individual – Type 1 NPI.
4. Reimbursement: Services performed outside the clinic setting will be reimbursed under Fee-for-Service (FFS) methodology.

Is Your Michigan Medicaid Maternity Billing Ready for 2027? 

Patients with due dates after January 1, 2027, are already scheduled, so the transition begins with this year's prenatal visits rather than next year's claims. BillingFreedom's COBGC-certified OB/GYN billers and coders support Michigan practices, FQHCs, RHCs, and Tribal Health Centers in moving from global billing to per-encounter reporting while maintaining revenue.

• Transition planning for 2026–2027 pregnancies. We sort active OB patients by due date and bill 2026 antepartum care correctly, so nothing gets stuck between old and new codes.
• Per-encounter coding with Modifier TH. We code each routine antepartum and postpartum E/M to the documented MDM or time, with TH and the correct pregnancy diagnosis codes, so eligible visits qualify for Michigan's enhanced OB rate.
• Visit-count tracking. We track every pregnancy against the 13 antepartum and 2 postpartum enhanced-rate visits, so you know in advance how each visit will pay.
• Clinic and hospital claims, split correctly. For FQHCs, RHCs, and THCs, we separate in-clinic encounters from hospital labor and delivery care and submit hospital services on the 837P with the correct Type 2 billing and Type 1 rendering NPIs.
• Review before submission. We check labor management, delivery and postpartum claims against CPT and Michigan Medicaid rules before they go out, catching same-day bundling issues before they become denials.