Starting January 1, 2027, the way maternity billing is handled is changing. The American Medical Association (AMA) is retiring the global obstetric billing model, which has traditionally bundled care for the entire pregnancy into a single code. Instead, maternity care will be billed in four separate phases: antepartum care, labor management, delivery and postpartum care.
It's a significant change to obstetric coding and one that will affect hospitals that employ OB/GYNs or midwives or oversee women's and children's service lines. And it's happening at a particularly difficult time, as many hospitals are already determining whether they can afford to keep obstetrics open. For CFOs, the question is how the 2027 maternity coding changes could affect revenue, physician subsidies and the financial viability of an already vulnerable service line.
Table of Contents
What Is Changing in the 2027 Maternity Coding Update?
The AMA is deleting 17 legacy maternity codes, adding 12 new codes and revising 6 more to support the new phase-based structure.
| Phase | What Changes |
| Antepartum care | Global antepartum codes are deleted. Care is billed per encounter using standard E/M codes, based on time or medical decision-making, regardless of setting (office, hospital or telehealth). |
| Labor management | New code category created for the first time. Reported once per calendar day, split by complexity (straightforward vs. complex) and by initial vs. subsequent day. |
| Delivery | Streamlined, distinct codes for vaginal delivery (including VBAC and episiotomy variations) and cesarean delivery (primary vs. repeat). New codes added for third- and fourth-degree laceration repair and post-cesarean hysterectomy. Delivery is billed independently of labor management. |
| Postpartum care | Global postpartum codes are deleted. Routine care on the day of delivery is bundled into the delivery code; every subsequent visit is billed as its own E/M encounter. |
- The global maternity codes being retired has been in place for more than 30 years, according to both Mercer Government and Health Information Associates.
Today, care teams routinely include laborists, certified nurse midwives and advanced practice providers across multiple sites and shifts and a single global code cannot show who performed which portion of care.
American College of Obstetricians and Gynecologists’ (ACOG's) Committee on Health Economics and Coding submitted the application to eliminate the global obstetric payment and the CPT Editorial Panel accepted the proposal in September 2025, per Mercer. Nearly two years of work between the CPT Editorial Panel, ACOG and other specialty societies followed.
How Will the 2027 Maternity Coding Changes Affect Hospital Reimbursement?
For CFOs, the first question is: where does the financial risk actually exist?
- According to the Washington State Hospital Association, hospitals should not expect a significant change in facility reimbursement.
The CPT codes for the deliveries themselves are largely staying intact. The bigger change is how professional prenatal, labor and postpartum services are being billed. The impact can still reach the hospital, though. Many hospitals employ their OB/GYNs or help subsidize their practices, making revenue cycle performance an important part of the equation. If physicians aren't able to capture and bill for their work under the new system, hospitals could end up making up the difference. What will require more attention is the documentation and coding behind that care. Each phase of the pregnancy will need to be captured separately, with the appropriate provider identified and the documentation to support the services billed. Under the global model, one code represented the entire pregnancy episode, which simplified billing.
- However, starting in 2027, care will be reported more granularly across four phases: antepartum, labor management, delivery and postpartum.
That means organizations will need documentation that supports the services being reported and the providers who performed them.
How Will this Impact Rural Hospitals?
This could be especially challenging for rural and community hospitals that rely on call coverage, locum providers or teams working across multiple locations. When several clinicians are involved in the same patient's care, keeping track of who provided each service and making sure the documentation supports the billing can become much more difficult.
The timing is also challenging for rural obstetrics. Low patient volumes and inadequate reimbursement have already led some hospitals to reconsider or close services, including obstetrics and chemotherapy. When those services disappear, patients may have to travel much farther for care, and outcomes can suffer.
That makes getting ahead of the coding change even more important. Hospitals may not see a new expense from the change itself, but they could lose revenue if their documentation and billing processes aren't ready. CFOs should be asking now whether their teams can track each phase of care, identify the providers involved and capture the services accurately once the new codes take effect.
What is the Timeline for the 2027 Maternity Coding Changes?
| Milestone | Date |
| CPT Editorial Panel accepts restructuring proposal | September 2025 |
| RUC survey of 650+ obstetricians, family medicine physicians and nurse midwives | September 2025 |
| Survey data presented to the RVS Update Committee | January 2026 |
| RUC submits valuation recommendations to CMS | February 3, 2026 |
| CMS releases Medicare Physician Fee Schedule Proposed Rule | July 14, 2026 |
| CMS publishes Final Rule | Early November 2026 |
| New codes take effect; deleted codes rejected by claims systems | January 1, 2027 |
- The RUC has indicated the new codes are expected to be budget neutral in aggregate, meaning total RVUs for the new code set should not exceed what the former bundled codes paid out.
Even if the overall change is budget neutral, that doesn't mean every hospital, practice or provider will see the same financial results. Much will depend on how well organizations document and capture each phase of care. Those that have systems in place to track services separately will be better positioned than those still relying on processes built around the global model.
- According to the AMA's FAQ, the deleted codes will no longer be valid for dates of service on or after January 1, 2027, and claims using them are expected to be rejected.
Are Payors Already Adopting the New Maternity Codes?
CFOs should not assume the changes begin on January 1.
- Point32Health, which includes Harvard Pilgrim and Tufts Health Plan, has already issued updated antepartum billing guidance for dates of service beginning August 1, 2026.
Other commercial and Medicaid payors may make similar changes before the January 2027 deadline. That means hospitals need to look beyond the 2027 CPT changes themselves and find out when each of their major payors plans to adopt them.
Medicaid deserves particular attention.
- For example, OB services account for a significant share of Medicaid volume andMercer Government points to changes in claims submission timing, MCO contract definitions and rate-setting assumptions.
For rural and community hospitals with a large Medicaid OB population, understanding those payor-specific requirements now can help prevent surprises when the new codes take effect.
What Should Hospital CFOs Do to Prepare for 2027?
For hospital CFOs, review current workflows, update EHR templates and billing systems, and train staff and payors ahead of the transition. That translates into five priorities before January 1:
- Audit current OB documentation against the four-phase structure. Identify where documentation currently supports only bundled billing and would fall short of the granular, per-phase requirements.
- Rebuild EHR templates and charge capture workflows. Templates built for a single global charge need to prompt for the level of detail, time, complexity, medical decision-making, that the new E/M and labor management codes require.
- Train coding staff and providers together. This is not a coding-department-only transition. Physicians, midwives and APPs need to understand what documentation drives correct code selection, particularly the straightforward-versus-complex distinction in labor management.
- Stress-test physician compensation models. Compensation plans built around wRVUs tied to the old global codes should be modeled against the new discrete codes before the effective date, especially for team-based coverage arrangements.
- Engage payors early. Some payors, including Point32Health, are already issuing updated guidance ahead of the full 2027 transition. Confirm effective dates and interim billing requirements with each major payor rather than assuming everything changes uniformly on January 1.
How Can Hospitals Protect Their OB Service Line Through This Transition?
For many hospitals, especially rural and community facilities, obstetrics is already a financially difficult service line. That makes getting the billing changes right even more important. Hospitals should start reviewing their documentation and workflows now, while there is still time to make changes before the final CMS values are published in November.
Documentation audits, EHR changes and compensation modeling all take time, and hospitals will have only a few weeks to respond once the final values are released. The work that can protect OB revenue in 2027 needs to start well before January 1.
Ready to Prepare for the 2027 Maternity Coding Changes?
If you're not sure how prepared your OB documentation and coding workflows are for the 2027 maternity coding changes, JTS Health Partners can help you take a closer look. JTS can assess your current workflows, identify potential gaps and help you understand where they could affect revenue.
