South Dakota Medicaid: Maternity Billing Before 2027

South Dakota Medicaid allows providers to bill prenatal visits, delivery, and postpartum care separately for services provided through December 31, 2026. This gives OB/GYN practices and maternity providers the option to begin billing separately before the new maternity coding rules take effect on January 1, 2027.

Providers may use global OB codes if all required maternity care takes place in 2026. If any part of the global package extends into 2027, they must bill each service separately for the entire pregnancy episode.

OB/GYN practices, nurse midwives, and billing teams should check prenatal, delivery, and postpartum dates before choosing a billing method.

Maternity Care Spanning 2026 and 2027

South Dakota Medicaid’s September 4, 2026 billing update explains that providers must bill each service individually when maternity care covered by the global package extends into 2027.

This applies even when most of the patient’s care took place in 2026.

If a previously submitted global claim no longer qualifies because the pregnancy extends into 2027, the provider must void it and submit the individual claims within the filing deadline.

Review expected delivery dates and postpartum appointments early to identify pregnancies that may need a different billing approach.

The 2026 codes discussed below are for eligible services provided before the transition. They aren’t a complete guide to the new codes taking effect in 2027.

Four Phases of Maternity Care

Maternity care is divided into four phases:

• Antepartum care: Prenatal checkups, monitoring, counseling, and care before labor.
• Labor management: Monitoring and caring for the patient during labor.
• Delivery: Vaginal or cesarean birth and related services.
• Postpartum care: Follow-up visits and routine care during recovery after delivery.

Under South Dakota Medicaid’s 2026 individual billing option, labor and delivery are treated as one billing component.

Separate Maternity Billing Through December 31, 2026

South Dakota Medicaid lets providers bill eligible maternity services individually instead of using a global OB code through December 31, 2026.

Antepartum Care

For individual billing, providers can bill each prenatal visit with the appropriate E/M code, pregnancy-related ICD-10-CM diagnosis, and TH modifier.

The Medicaid manual lists CPT 99202–99499 as the E/M code range for prenatal and postpartum care.

Choose a code based on the visit, care setting, and medical records. Not every code within this range is appropriate for routine prenatal appointments.

Labor and Delivery

For delivery services, providers can use the applicable delivery-only codes listed in the comparison table below.

These codes include immediate postpartum care provided on the same calendar day as delivery.

The Medicaid manual also covers hospital care through discharge and postsurgical care after a cesarean delivery. Some services may overlap, so review Medicaid’s billing rules before charging separately for inpatient care.

Postpartum Care

With individual billing, providers can use the appropriate E/M code for each postpartum visit.

For routine postpartum follow-up, report Z39.2 with the TH modifier, as required by Medicaid.

If the patient receives treatment for a postpartum complication, report the diagnosis supported by the medical record.

A Look at Global OB Billing

Under South Dakota Medicaid’s standard billing rules, global maternity care covers routine prenatal visits, delivery, and postpartum care under one package.

To qualify, one practitioner or providers within the same physician or group practice must perform at least four antepartum visits, delivery, and postpartum care.

When billing the global package, use the delivery date as the claim’s date of service.

The global package covers routine prenatal visits, chemical urinalysis, uncomplicated labor, delivery, and routine postpartum care.

Some services aren't part of the package, including certain lab tests, obstetric ultrasounds, and treatment for conditions unrelated to pregnancy. These services may be billed separately, depending on medical necessity, documentation, insurance coverage, and coding requirements.

Partial-care billing may apply when a patient transfers to another provider, receives delivery services elsewhere, experiences pregnancy loss, or changes insurance during pregnancy.

These situations follow the standard partial-care rules, which differ from the temporary option to bill each maternity encounter separately.

2026 Maternity Billing Codes

The table below shows the maternity codes for eligible services provided in 2026.

Delivery type	Full global care	Delivery only	Delivery & postpartum care
Vaginal delivery	59400	59409	59410
Cesarean delivery	59510	59514	59515
Vaginal birth after cesarean (VBAC)	59610	59612	59614
Cesarean following attempted VBAC	59618	59620	59622

Global maternity codes cover routine prenatal visits, delivery, and postpartum care in one package. Delivery-with-postpartum codes include the birth and postpartum care but leave out prenatal services.

Check the Medicaid manual’s coverage, eligibility, and service-date rules before selecting a code.

For more information, read BillingFreedom’s CPT 59400 global obstetric care guide.

Prenatal-Only and Postpartum-Only Billing

When a provider handles only part of the patient’s maternity care, South Dakota Medicaid’s standard partial-care rules may apply.

Services provided	Reporting approach
Three or fewer antepartum visits	Appropriate E/M codes
Four to six antepartum visits	CPT 59425
Seven or more antepartum visits	CPT 59426
Postpartum care only	CPT 59430

CPT 59425 and 59426 cover the routine antepartum visits included in their respective packages. Don’t bill those same visits again using individual E/M codes or combine both antepartum-only codes for the same care.

If the practice provides antepartum care and delivery but not postpartum services, use the applicable antepartum-only and delivery-only codes.

These standard partial-care rules are different from South Dakota Medicaid’s temporary individual billing option for 2026.

For related coding information, see BillingFreedom’s CPT 59426 antepartum care guide and CPT 59430 postpartum care guide.

South Dakota Medicaid’s own billing requirements should guide claim selection for covered members.

Provider and Coverage Exceptions

Medicaid billing requirements vary by provider type and coverage category.

FQHC, RHC, IHS, and Tribal 638 Providers

South Dakota Medicaid’s standard billing manual requires Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Indian Health Service (IHS) facilities, and Tribal 638 providers to bill prenatal and postpartum services separately.

For prenatal visits, use the applicable E/M code and pregnancy-related diagnosis. Add the TH modifier, except for the initial visit when pregnancy is confirmed.

The standard manual instructs these providers to use CPT 59430 for postpartum-only care.

South Dakota Medicaid’s transition option also permits postpartum E/M reporting. Providers should check how the temporary rules apply to their encounter-based billing and payment arrangements before submitting claims.

Unborn Children Prenatal Care Program: Aid Category 79

South Dakota Medicaid’s Unborn Children Prenatal Care Program has separate coverage limits.

Under Aid Category 79, the mother’s eligibility ends after delivery, so Medicaid doesn’t cover CPT 59430 as a standalone postpartum service.

The manual allows postpartum care to be reported through specified delivery-with-postpartum codes, using the delivery date as the service date.

The temporary individual billing option doesn’t extend the patient’s Medicaid eligibility. Check coverage and billing requirements before submitting claims for these members.

Common Questions About South Dakota Maternity Billing

Can a December 2026 Delivery Be Billed Globally if Postpartum Care Occurs in 2027?

No. South Dakota Medicaid requires providers to bill each service separately if any part of the global maternity care package continues into 2027.

This applies even if the patient delivered in December 2026.

Can Prenatal Visits Be Billed Separately Along With a Global OB Code?

No. Global maternity codes already include routine prenatal care, so you can't bill the same visits separately.

When providers choose individual billing for a pregnancy episode, they must use that method consistently throughout the episode.

If the entire episode ends in 2026 and global billing is appropriate, Medicaid allows claim corrections under its transition rules. The two billing methods shouldn’t be combined for the same pregnancy.

What Does the 2027 Maternity Billing Transition Mean for Your Practice?

South Dakota Medicaid has different billing rules for pregnancies continuing into 2027. Before submitting claims, OB/GYN billing teams should check the patient’s service dates, earlier charges, and whether care was billed globally or separately.

Here's what your practice needs to check:

- Review pregnancies continuing into 2027. Check prenatal visits, delivery, and postpartum care before using global billing. If any part of the package extends into 2027, bill each service separately, even for December 2026 deliveries.

• - Check how each pregnancy is billed. Track global vs. separate billing, follow the same method throughout the episode, and coordinate with other providers to avoid duplicate claims.
• - Review global claims if care dates change. If maternity care extends into 2027, void the affected global claim and bill each service separately within the filing deadline.
• - Review E/M codes and modifiers. For separate billing in 2026, check E/M codes, pregnancy-related diagnoses, and TH modifier requirements. Use Z39.2 for routine postpartum care and confirm Medicaid rules before billing inpatient services that may already be included in delivery charges.
• - Review provider and coverage rules. Check billing requirements for FQHCs, RHCs, IHS facilities, and Tribal 638 providers. Aid Category 79 eligibility doesn't extend under the transition option. Verify coverage, provider enrollment, and codes for each service date.

Need Help Preparing Your Maternity Claims for 2027?

South Dakota Medicaid’s billing changes require OB/GYN practices to pay closer attention to prenatal visit records, delivery dates, postpartum care, and previously submitted claims.

BillingFreedom provides OB/GYN medical billing services to help practices review coding, prepare maternity claims, and follow up on billing issues.

Our team can review pregnancy records, previous claims, and Medicaid billing requirements to identify potential coding and submission problems.

Talk to our business associate at BillingFreedom to review your maternity billing workflow and make any needed changes before the 2027 transition.

References

• South Dakota Medicaid: Obstetrical Services Billing Manual
• South Dakota Medicaid: September 2026 Maternity Billing Update