Oregon Maternity Coding Changes for 2027: Provider Preparation Guide.

Oregon Health Authority (OHA) QHOC presentation, September 14, 2026 · Read the OHA QHOC slides

At the September 14, 2026 Quality and Health Outcomes Committee (QHOC) meeting, the Oregon Health Authority (OHA) confirmed that global maternity codes will end on 2027-01-01, with antepartum and postpartum visit billed as E/M codes with labor management and delivery billed separately. A policy on pregnancies that cross the cutoff date is still under review, and OHA plans to use CMS values to set budget-neutral rates. Furthermore, HERC staff recommended placing the updated maternity codes on the covered Prioritized List lines. However, OHA has not issued final guidance on provider billing.

The challenge for Oregon providers is timing. The national maternity coding structure changes on January 1, 2027, but OHA has not finalized three details: which code set it will adopt, how to bill cases that cross from 2026 into 2027, and how it will set rates.

2027 Maternity Coding Restructures the Global Billing Model

As stated in OHA's presentation, the AMA has revised the procedure codes used to bill maternity services. These changes eliminate global maternity coding, introduce new labor and delivery codes, and replace antepartum and postpartum care codes with Evaluation and Management (E/M) codes.

OHA described the revision as the most significant change to maternity coding in decades, with the global maternity codes taking effect on January 1, 2027. The coding changes proposed by OHA are as follows:

• 12 new codes
• 17 terminated codes
• 7 revised codes

At the QHOC presentation on September 14, OHA also announced it would finalize the AMA code set that day. Moreover, OHA made it clear that a comprehensive review of its entire maternity policy was not within the scope of the implementation effort starting on January 1, 2027.

Moving From Global Billing to an Unbundled Structure

According to the maternity code described by OHA, a single global code simplifies billing but can hide differences in the complexity and variety of services provided.

The future structure will be unbundled, with global maternity codes abolished, individual services reported in greater detail, and the maternity episode split into four distinct phases of care.

Four Phases of Maternity Care Will Be Reported Separately

Under the structure presented by OHA:

Phase of Care	2027 Reporting Structure
Antepartum care	Each visit billed using E/M codes
Labor management	New billing category
Delivery	Services billed separately
Postpartum care	Each visit billed using E/M codes

Instead of using a single global approach, this structure provides more detailed reporting throughout the maternity episode.

OHA Had Not Yet Selected CPT or HCPCS for Implementation

When the QHOC presentation took place, OHA had not yet decided whether to use CPT or HCPCS codes for its maternity billing implementation.

OHA said it wanted to avoid two different code structures and that its decision would consider the direction adopted by Oregon's coordinated care organizations (CCOs) and commercial insurers.

At the time of the presentation:

• OHA had not yet made its final decision on whether to choose CPT or HCPCS.
• Early indications favored CPT.
• OHA asked the CCOs to state their preferences.
• The different payers were aligned because OHA knew how difficult it was to run two separate coding systems.

Therefore, the claim in the presentation that the early signs favored CPT should not be taken to mean that OHA has finally adopted CPT.

2026-to-2027 Maternity Cases Require Separate Transition Policy

The January 1, 2027 effective date creates a particular billing problem for maternity episodes that begin in 2026 and extend into 2027.

For instance, a patient could get antepartum care before January 2027 but have labor and delivery after January 1, 2027. Since the global codes end on that date, OHA said it needs a specific policy for maternity cases that span the January 1, 2027 transition..

At the time of the QHOC meeting, OHA was evaluating whether antepartum care in these crossover cases should be reported using:

• E/M codes, or
• existing antepartum codes.

The presentation did not include any final methodology for crossover. Providers must therefore wait for further policy guidance before treating either method as OHA's final billing requirement.

OHA Intends the Coding Transition to Be Budget Neutral

The OHA said its reimbursement policy is intended to ensure the maternity coding transition is budget neutral.

The presentation stated that any general increase or decrease in reimbursement would be outside the policy's intended outcome. OHA noted concerns on both sides of the reimbursement calculation.

A general decrease in reimbursement might affect network sufficiency, while an increase could have a major impact on the Medicaid budget. The presentation also stated that HR 1 has cut back funding for Medicaid programs and described an overall increase in funding as unsustainable.

Budget neutrality reflects OHA's policy intention, but it should not be understood as ensuring that each provider, service, maternity episode, or individual claim will be paid exactly the same amount under the new system.

Reimbursement Methodology Was Still Under Development

Several factors influenced how OHA developed reimbursement rates for the new maternity coding structure.

The agency cited the choice of code set as one consideration and said it had not had enough time or data to fully assess the relative value units (RVUs). OHA's rate considerations also assumed that CMS would achieve budget neutrality.

OHA also said that having the actual claims information would enable the CMA and OHA to modify the rates. In this statement, the presentation refers to "CMA".

Tentative Rate Approach

The approach presented by OHA was explicitly described as tentative:

Use the maternity conversion factor that is provided by CMS.

Since OHA has marked this method as tentative, it should not be offered as the final Oregon reimbursement method.

Providers should treat OHA's aim of budget neutrality as distinct from the specific rate method that will ultimately be adopted.

Three Oregon Policy Decisions Were Still Pending

At the conclusion of the maternity coding discussion, OHA identified three primary policy decisions that still required resolution:

1. The choice between CPT and HCPCS is based on CCO feedback.
2. The billing process for maternity cases in 2026 and 2027.
3. Adoption of CMS rates.

These items matter because the AMA coding restructuring and the abolition of the global maternity codes on January 1, 2027, do not, by themselves, set all the requirements for billing and reimbursement under Oregon Medicaid.

What Oregon Providers Can Prepare for Now

Based only on the issues mentioned in OHA's presentation, billing and revenue-cycle teams can implement internal systems without treating unresolved OHA decisions as final payer requirements.

Practices need to handle the shift from global billing to reporting antepartum, labor-management, delivery, and postpartum services separately. Additionally, coding and billing procedures should support E/M reporting for individual antepartum and postpartum visits within the new structure.

People should focus on maternity cases that span January 1, 2027, since OHA has not yet decided how to manage 2027 antepartum services in those cases. Meanwhile, billing teams should also refrain from hard-coding a final decision on CPT versus HCPCS or a final reimbursement method until OHA has made the policy decisions still pending from the QHOC meeting.

Confirmed Changes vs. Pending Oregon Decisions

 

Area	Status in OHA's September 2026 Presentation
Global maternity codes end January 1, 2027	Confirmed coding change
12 new, 17 terminated, and 7 revised codes	Reported by OHA
Antepartum visits billed individually using E/M codes	Part of new code structure
Postpartum visits billed individually using E/M codes	Part of new code structure
New labor-management billing category	Part of new code structure
Delivery services reported separately	Part of new code structure
OHA adoption of CPT versus HCPCS	Pending
Billing method for cases spanning 2026–2027	Pending
Use of E/M or existing codes for crossover antepartum care	Under evaluation
Budget-neutral reimbursement	OHA policy intent
CMS-provided rates with existing maternity conversion factor	Tentative
Final adoption of CMS rates	Pending

This distinction matters for implementation. While the new national coding structure can be included in readiness planning, the Oregon-specific decisions OHA has identified as pending should not become definite billing rules until further guidance is issued.

Prepare Your Maternity Billing Workflow Before the 2027 Cutover

The shift from global maternity billing to separately reporting the various phases of care will affect coding, charge capture, claim configuration, and workflows for episodes that cross the January 1, 2027 effective date. Oregon practices must also keep their final requirements separate from OHA policies still under development.

Billing Oregon Health Plan maternity patients? BillingFreedom will flag every pregnancy that crosses January 1, 2027, set up separate antepartum, labor, delivery and postpartum charge capture, and update your workflow as soon as OHA publishes its final decisions. Request a free maternity transition review.

FAQ's

When do global maternity codes end in Oregon?

January 1, 2027.

Will Oregon Medicaid use CPT or HCPCS for maternity billing?

Not decided yet. Early indications favor CPT.

How will Oregon bill pregnancies that cross January 1, 2027?

OHA is still deciding whether antepartum care uses E/M codes or existing antepartum codes.

Will Oregon maternity reimbursement change?

OHA intends the change to be budget neutral overall. The rate method is tentative.