North Carolina Medicaid 2027 Maternity Coding Changes Effective Jan. 1, 2027 

NC Medicaid removes the current maternity codes, including the OB globals, from its fee schedule and is adopting the AMA 2027 codes on 2027-01-01. Current maternity service codes, including global maternity billing, will be deleted from the NC Medicaid fee schedule and replaced by the new maternity billing codes.

This change applies to NC Medicaid Direct and NC Medicaid Managed Care. Providers should be aware of the transition requirements that begin before the new codes take effect.

From beginning Sept. 1, 2026, NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use E/M codes 99202–99215 with the TH modifier to report prenatal or postpartum care .These codes should be used for,

When to use E/M codes 99202–99215 with the TH modifier:

These codes apply to:

• All claims and documentation for  beneficiary’s first prenatal visit after pregnancy confirmation.
• Antepartum visits where the delivery and/or postpartum is expected after Jan. 1, 2027.

The appropriate ICD-10-CM code and weeks of gestation should also be reported for verification. Documentation must support the reported E/M service based on medical decision making or time under CPT guidelines.

Maternity Billing Rules Before Jan. 1, 2027 

For pregnancies where the postpartum visit is completed before Jan. 1, 2027, providers may continue billing the existing maternity codes. This includes global codes, which would be the 59425 (Antepartum care only; 4-6 visits)  and 59426 (Antepartum Care only; 7 or more visits) may be billed.

Health plans may not require individual E/M codes instead of the current bundled maternity codes for dates of service before Jan. 1, 2027.

Before Jan. 1, 2027, Providers Should

• Continue using the existing maternity codes when the pregnancy is completed before the effective date.
• Use 59425 when four to six antepartum visits are reported.
• Use 59426 when seven or more antepartum visits are reported.
• Continue using applicable global maternity codes for eligible services.
• Use the transition E/M reporting approach for pregnancies expected to extend into 2027.

As NC Medicaid moves from the current maternity billing structure to the new 2027 requirements. Understanding which coding rules apply to each pregnancy will be important during the transition. Providers should follow the applicable requirements based on the expected timing of delivery and postpartum care.

BillingFreedom helps North Carolina OB/GYN practices stay current with payer-specific maternity coding changes and maintain accurate billing as requirements change. Current maternity changes in North Carolina will hit some practices harder than others, depeidng on the payer mix. Our billing and coding team can review your North Carolina maternity workflows and support preparation for 2027.

Resources

Medicaid.NCDHHS.gov - NCDHHS NC Medicaid Division of Health Benefits

2027 OB billing: NC Medicaid drops global maternity codes 2027-01-01; E/M + TH bridge from Sept 2026