Point32Health (Harvard Pilgrim and Tufts Health Plan) 2027 Maternity Coding Changes: What OB/GYN Practices Need to Know

Maternity care coding is entering a significant transition beginning January 1, 2027. As the CPT code set changes, the way maternity services are reported and processed will also change, moving away from the current bundled approach toward a more service-level reporting structure.In its October 2026 provider update, following an August 2026 item on the industrywide change, Point32Health has updated its Obstetrics/Gynecology Payment Policy effective for dates of service on or after January 1, 2027  to reflect these changes and help providers understand which coding guidance applies before and after the effective date.

What Is Changing in Maternity Care Coding?

The current maternity coding model is largely based on bundled or global billing, which does not always reflect how obstetric care is delivered across multiple clinicians, practices, and health systems. Beginning January 1, 2027, the new coding structure will place greater emphasis on reporting maternity services at the individual service level. This approach is intended to better reflect the increasingly complex, team-based nature of modern obstetric care.

Four Phases of the New Maternity Coding Framework

The new CPT maternity coding framework organizes maternity care into four defined phases. Each phase addresses a specific part of the maternity care process:

• Antepartum Care: Covers the management of pregnancy before the onset of labor.
• Labor Management: Includes decision-making to assess, support, and balance the well-being of the pregnant person. Labor management codes report initial and subsequent days of labor management for a pregnant person admitted to the facility.
• Delivery Care: Begins when labor is complete or interrupted and includes management of the mother and newborn(s).
• Postpartum Care: Covers ongoing assessments after delivery and is reported on a calendar date other than the delivery date.

AMA Guidance for the Updated Maternity Coding

Point32Health’s updated maternity coding supports the American Medical Association (AMA) guidelines for the revised maternity care section of the CPT code set. Although these guidelines have not yet been finalized, they were made available in advance to help providers prepare for the significant maternity coding revisions taking effect with the 2027 CPT code set.

Maternity Coding Is Changing, Not Maternity Care

Members will continue to have access to the same maternity care they receive today. The change applies to how these services are billed, reported, and processed, rather than to the maternity care itself.

The new coding hierarchy is designed to more accurately reflect the complexity of contemporary obstetrics, where care might be delivered by several practitioners in different practices and health systems during the course of pregnancy. The present method of “bundled” or “global billing” is being phased out and replaced by a maternity care system that provides more granular reporting at the service level. 

Antepartum Care Delivered in 2026

When antepartum care begins in 2026 and the expected delivery is in 2027, visits provided during 2026 should continue to be reported using the applicable CPT coding based on the number of visits during the calendar year:

• 59425: 4–6 antepartum visits
• 59426: 7 or more antepartum visits
• E/M codes: Fewer than 4 visits

Note that the count is of visits in the 2026 calendar year only, not the whole pregnancy. A patient confirmed in October with three visits before December 31 is billed with E/M codes for 2026; her 2027 visits are then billed per encounter under the new rules.

This guidance will change beginning in 2027. CPT codes 59425 and 59426 will be deleted, and antepartum visits will instead be reported per encounter using the appropriate E/M procedure code based on the patient’s location.

What This Means for Your Practice

• Where a Harvard Pilgrim or Tufts patient is due in 2027, its important to bill her 2026 prenatal visits separately. For any visit up to December 31, 2026, use code 59425, 59426, or an E/M code.
• Read the updated Obstetrics/Gynecology Payment Policy now; it holds the 2027 code structure for labor management, delivery and postpartum care, which this notice only outlines. A redlined version showing the changes is posted temporarily.
• Build 2027 E/M templates by place of service (office, hospital outpatient, inpatient); antepartum visits will be reported per encounter, and the E/M code depends on where the patient is seen.
• The AMA guidelines are still not final. Expect one more revision before January; watch the Point32Health provider updates page.

BillingFreedom tracks each payer's maternity transition rules so your OB/GYN team doesn't have to. Email info@billingfreedom.com to review your Harvard Pilgrim and Tufts maternity claims before year-end.

Keeping Maternity Billing Workflows Aligned

BillingFreedom stays current with evolving maternity coding guidance, helping practices understand reporting changes and maintain accurate billing workflows as the new framework takes effect. Staying informed about the applicable coding requirements can support a smoother transition as maternity services move to the updated reporting structure.