Virginia Medicaid 2027 Maternity Care Billing and Coding Changes

DMAS bulletin issued September 16, 2026 · Read the official DMAS bulletin 

The DMAS notice covers FFS and managed care; it states that six bundled maternity codes ( 59400, 59425, 59426, 59510, 59610, 59618, and the like) will be replaced with E/M codes 99202 to 99215 with the TH modifier O- or Z-series diagnosis codes, and 0500F on the initial visit for members whose pregnancies begin on or after 2027-01-01. Detailed implementation guidance will be provided before January, and the MCOs can establish their own rules.

Virginia Medicaid will move to a new maternity care coding system, effective January 1, 2027, after the American Medical Association (AMA) revises its Current Procedural Terminology (CPT®) code set for maternity care services.

On 16 September 2026, the Virginia Department of Medical Assistance Services (DMAS) issued a bulletin to enrolled fee-for-service (FFS) providers and managed care organizations (MCOs) on expected changes to maternity care coding and billing requirements during pregnancy.

The change will affect how providers report prenatal services, including Evaluation and Management (E/M) codes, the modifier TH, pregnancy-related ICD-10 diagnosis codes, and CPT Category II code 0500F. Providers must also prepare for the deletion of the specified bundled or global maternity CPT codes starting on January 1, 2027.

Virginia Medicaid's New Maternity Coding Structure Effective January 1, 2027

DMAS will adopt a new coding system for maternity care services effective January 1, 2027.

To prepare for the change, DMAS recommends that providers begin billing applicable prenatal visits using:

• E/M codes 99202–99215
• Modifier TH
• Appropriate pregnancy-related O-series or Z-series ICD-10 diagnosis codes
• CPT Category II code 0500F for all initial prenatal visits

The method of billing in question applies to members whose estimated date of delivery (EDD) is on or after January 1, 2027.

E/M Codes and Modifier TH Requirements

When reporting the appropriate prenatal visits, the E/M CPT codes 99202 through 99215 must be used in conjunction with the TH modifier and an appropriate pregnancy-related O- or Z-series ICD-10 diagnosis code.

At the patient's first prenatal visit, providers must also report Category II CPT code 0500F.

How the Estimated Due Date Affects Billing

Virginia Medicaid guidance for the transition separates cases where the estimated due date is before January 1, 2027 from those where the EDD is on or after January 1, 2027.

Estimated Due Date	Billing Structure	Applicable Dates of Service
Before January 1, 2027	Current bundled CPT codes 59400, 59425, 59426, 59510, 59610, and 59618	Through December 31, 2026
On or after January 1, 2027	New E/M coding structure with defined modifiers	Mandatory for all dates of service on or after January 1, 2027

For providers who were caring for members with an EDD before January 1, 2027, billing can continue under the current guidance until December 31, 2026.

January 1, 2027 Date-of-Service Cutoff

The date-of-service requirement becomes important when the new year starts.

The AMA will delete the affected bundled/global maternity codes effective January 1, 2027, so claims with dates of service on or after that date must use the new maternity coding structure, no matter when the patient's maternity care started.

For applicable prenatal services on or after January 1, 2027, providers must use:

1. E/M CPT codes 99202–99215
2. Modifier TH
3. Appropriate pregnancy-related O- or Z-series ICD-10 codes
4. 0500F for initial prenatal visits

From January 1, 2027 forward, the new system will apply based on the date of service, even if the patient's course of care began in 2026.

Bundled Maternity CPT Codes Being Deleted for 2027

Virginia Medicaid will delete and make unavailable six bundled/global maternity CPT codes that currently exist for services on or after January 1, 2027.

CPT Code	Description
59400	Vaginal Delivery with Antepartum and Postpartum Care
59425	Antepartum Care Only; 4–6 Visits
59426	Antepartum Care Only; 7 or More Visits
59510	Cesarean Delivery with Antepartum and Postpartum Care
59610	Vaginal Delivery After Previous Cesarean (VBAC) with Antepartum and Postpartum Care
59618	Cesarean Delivery After Attempted Vaginal Delivery with Antepartum and Postpartum Care

The vaginal birth after cesarean (VBAC) is also mentioned in the DMAS bulletin when describing the maternity coding structure in question.

Six Steps Providers Should Complete Before January 1, 2027

DMAS has specified the implementation actions providers should start before the new coding structure takes effect.

1. Review the new CPT maternity care codes.

Providers should review the new maternity care codes the American Medical Association has released and assess how the new coding structure will affect their existing maternity billing procedures.

2. Provide education for both clinical and administrative staff.

Relevant staff should be made aware of the upcoming maternity coding changes so clinical, coding, billing, and administrative procedures can be coordinated before the changes are implemented.

3. Train the teams responsible for coding and billing.

Coding and billing staff should be trained on the new billing requirements, including the reporting structure that will replace the affected bundled/global maternity codes.

4. Evaluate EHR and charge capture workflows

They should assess their Electronic Health Record (EHR) workflows and charge capture procedures in order to work out the operational changes needed to support the new maternity coding structure.

5. Contact the payers regarding reimbursement.

Providers should contact the relevant payers to learn about updated reimbursement policies related to changes in maternity care coding.

Monitor guidance issued by Virginia Medicaid and Health Plans.

Monitoring should continue based on communications from Virginia Medicaid and individual health plans regarding any additional implementation requirements and payer-specific instructions.

Additional DMAS Implementation Guidance Is Still Forthcoming

The final implementation guidance for all aspects of the transition is not given in the September 2026 bulletin.

DMAS said it will release additional bulletins for providers and implementation guidance before January 1, 2027, as DMAS and its contracted MCOs carry out the system changes needed to support the new maternity care coding rule.

More guidance is also supposed to give further details regarding the coding changes.

Until further implementation instructions are issued, providers should carry out all of the current Virginia Medicaid documentation and billing requirements.

Provider Enrollment Must Remain Current in PRSS

The fact that you are preparing for the maternity coding transition does not mean that your existing obligations under Virginia Medicaid provider enrollment are canceled.

In order to avoid any disruption to claims processing via both the FFS and the MCOs, providers should regularly check the information available in the DMAS provider portal, which is called the Provider Services Solution (PRSS).

Providers should verify that the following information remains current for every applicable service location:

• Provider enrollment information
• Contact information
• License information

Because of the federal requirements, neither DMAS nor the MCOs will make payments to network providers who are not enrolled in PRSS.

For more information on provider enrollment and revalidation, you can refer to the MCO Provider Network Resources page, which provides resources, tutorials, and contact details for Gainwell.

Dental providers should keep on enrolling directly with Virginia Medicaid's Dental Benefits Administrator, DentaQuest.

Managed Care Providers Must Follow Plan-Specific Requirements

Virginia Medicaid offers two managed care programs: Cardinal Care Managed Care and the Program of All-Inclusive Care for the Elderly (PACE).

When providing services to a member who is enrolled in a managed care program, providers have to adhere to the contract that applies between them and the managed care plan or PACE provider.

Managed care requirements may differ from those for Medicaid fee-for-service members, so providers should check the billing, authorization, reimbursement, and implementation instructions specific to each plan rather than assume the fee-for-service policy applies the same way to all managed care plans.

Virginia Medicaid Provider Resources and Contacts

Virginia Medicaid Web Portal Automated Response System

The Virginia Medicaid Web Portal Automated Response System provides access to information including:

• Member eligibility
• Claims status
• Payment status
• Service limits
• Service authorization status
• Remittance advice

Medical Audio Response System

Providers may use Medicall for:

• Member eligibility
• Claims status
• Payment status
• Service limits
• Service authorization status
• Remittance advice

Build a Controlled Transition to Virginia Medicaid's 2027 Maternity Billing Model

The January 1, 2027 transition is more than a code swap. Practices need to:

• Identify pregnancies that cross the January 1 cutoff

• Bill prenatal E/M visits with modifier TH and O- or Z-series diagnosis codes

• Report 0500F on every initial prenatal visit

• Update EHR templates and charge capture

• Track each MCO's implementation guidance

Billing Virginia Medicaid OB patients? BillingFreedom will review your active pregnancies, flag every patient whose care crosses January 1, 2027, and set up TH-modifier and 0500F charge capture before the cutoff. Request a free maternity billing transition review.

 

FAQ's

When do Virginia Medicaid maternity coding changes take effect?

January 1, 2027, for all dates of service.

What modifier does Virginia Medicaid require for prenatal E/M visits?

Modifier TH, with an O- or Z-series diagnosis code.

When is 0500F reported?

On every initial prenatal visit.

Can I still bill 59400 for a patient due in December 2026?

Yes, for 2026 dates of service. Any 2027 date of service must use the new structure.