OHCA 2027 Maternity Care Billing Changes

The Oklahoma Health Care Authority (OHCA) is preparing providers for a mandatory shift from legacy bundled maternal codes to the AMA’s unbundled maternity coding structure effective January 1, 2027. Beginning September 1, 2026, providers should start using individual Evaluation and Management (E/M) codes for new patients initiating prenatal care as part of the transition.Oklahoma's Official Website

Antepartum Billing Before January 1, 2027

Under the current guidance, for antepartum services provided before January 1, 2027, OHCA gives the following billing scenarios:

• 1–3 visits: Bill individual E/M codes.
• 4–6 visits: Bill CPT 59425 for the initial block of visits, then use individual E/M codes for ongoing visits.
• 7 or more visits: Bill CPT 59426. Do not bill additional E/M visit codes after CPT 59426 for services provided before December 31, 2026.

TH Modifier for Antepartum and Postpartum Care

OHCA asks providers to apply the TH modifier to E/M codes when billing antepartum or postpartum care to support proper claim processing & help avoid denials.

Delivery Billing Across the 2026–2027 Transition

As per 2006 transition rules, patients delivering before January 1, 2027 may still be billed using current bundled codes. Following the new rule, these bundled delivery codes cannot be used for patients who receive prenatal care in 2026 but deliver in 2027.

Preparing for January 1, 2027

Beginning January 1, 2027, OHCA will implement the AMA’s unbundled maternity coding structure, replacing legacy bundled maternal codes.

What OB/GYN Practices Should Review in Advance

• E/M billing for new prenatal patients;
• antepartum visit counts;
• CPT 59425 & CPT 59426 workflows;
• TH modifier setup;
• all maternity episodes crossing from 2026 into 2027;
• bundled and unbundled billing workflows;
• claim edits, EHR setup, and staff training.

OHCA states that it will release additional information, including provider education and guidance, as the transition progresses.

BillingFreedom Support

Experts at BillingFreedom help OB/GYN practices review OHCA maternity billing requirements, update E/M & TH modifier workflows, and prepare for the 2027 transition. Our team can support maternity claim review, coding workflows, and payer-specific billing follow-up. Contact BillingFreedom to review your OB/GYN billing process before the change.

Resources

Oklahoma.gov - OKLAHOMA Health Care Authority

2027 OB billing: OHCA adopts unbundled AMA maternity codes 2027-01-01; E/M + TH from Sept 2026