Nevada Medicaid and 2027 Unbundling Maternity Care Services Codes

Nevada Medicaid, including its managed care organizations, will not adopt the AMA's four-phase maternity code structure on Jan. 1, 2027. Providers must continue using the current bundled/global maternity codes until Nevada Medicaid changes its policy; the state is developing a new reimbursement model and expects to publish adoption details in announcements and public notices around mid-2027. OB practices and birth centers billing Nevada Medicaid, HPN Medicaid, Anthem NV Medicaid, Molina NV, or Silver Summit should keep the 2026 global codes in their 2027 claim edits for these payers.

Under the AMA 2027 Maternity coding reset, maternity care is divided into antepartum care, labor management, delivery, and postpartum care. Nevada Medicaid is actively developing and deploying a new reimbursement model that aligns with its ongoing commitment to improve maternity care and support appropriate provider reimbursement. This notice covers Nevada Medicaid and its MCO plans; however, commercial payer policies vary from payer to payer and plan to plan.

Global OB billing refresher

Under Nevadas Medicaid Provider guide, a physician is eligible for global OB payment only upon completion of at least seven prenatal visits, the delivery, and postpartum care. If the full package is not provided, use partial care coding. Verify any additional requirements with the member’s Medicaid managed care plan.

Partial care: Bill appropriate E/M codes for 1–3 visits, 59425 for 4–6 visits, and 59426 for 7 or more visits for prenatal-only care, and use 59430 for postpartum-only care.  If delivery follows fewer than seven prenatal visits, bill the applicable prenatal care separately from the delivery code, with postpartum care if rendered.

BillingFreedom helps OB/GYN practices navigate payer changes, strengthen maternity coding, and keep claims moving. For a review of your Nevada maternity billing workflow, visit billingfreedom.com.