The American Medical Association (AMA) has announced a major revision to the Current Procedural Terminology (CPT) codes for maternity care, replacing the longstanding global maternity packages with an itemized billing structure effective January 1, 2027. The change aims to improve payment accuracy, enhance transparency for patients and payers, and better reflect the variable complexity and resource use in prenatal, delivery, and postpartum care though it has sparked debate among obstetricians over potential administrative burden and reimbursement uncertainty.
Glimpse:
Under the new system, providers will bill separately for prenatal visits, delivery services, postpartum care, and ancillary procedures rather than using bundled global codes (59400, 59510, etc.). The transition will begin with a phased rollout in 2026 for education and system updates, with full implementation in 2027. The AMA cites evolving care models (increased high-risk pregnancies, more collaborative care with midwives, and rising cesarean rates) as the rationale, while critics argue it could fragment billing, increase documentation demands, and create payment instability during the shift.
The American Medical Association’s CPT Editorial Panel has voted to sunset the traditional global maternity care codes and replace them with a modular, itemized billing framework starting January 1, 2027. The decision, finalized after extensive stakeholder input and economic analysis, ends a decades-long era of bundled payment for routine obstetric care and moves toward greater granularity in reporting and reimbursement.
Under the current global codes (e.g., 59400 for vaginal delivery, 59510 for cesarean), a single code encompasses all routine prenatal visits, delivery, and postpartum care typically 1 antepartum visit per month up to 28 weeks, biweekly to weekly thereafter, delivery, and postpartum visits through 6 weeks. The bundled structure simplifies billing but has been criticized for not adequately reflecting variations in care complexity, such as high-risk pregnancies requiring frequent monitoring, additional ultrasounds, non-stress tests, or collaborative management with maternal-fetal medicine specialists.
The new itemized system will allow separate reporting for:
- Individual antepartum evaluation & management (E/M) visits
- Delivery-only services (vaginal, cesarean, assisted)
- Postpartum care episodes
- Ancillary procedures (e.g., fetal monitoring, amniocentesis, cerclage, external cephalic version)
- Management of complications (e.g., preeclampsia, gestational diabetes, preterm labor)
The AMA and CPT panel have stated that the change will improve payment equity, enable more precise tracking of resource use, and support value-based care models that reward appropriate care intensity rather than volume. It also aligns with evolving practice patterns, including increased use of group prenatal care, midwifery collaboration, and telehealth for routine visits.
However, the American College of Obstetricians and Gynecologists (ACOG) and several state OB-GYN societies have voiced concerns. They argue that itemized billing could increase administrative workload, documentation requirements, and audit risk for providers particularly in rural and underserved areas where staffing is already limited. There are also worries about potential reimbursement volatility during the transition and the possibility that payers may undervalue certain components of routine maternity care when unbundled.
To ease the transition, the AMA has committed to a 12-month educational and preparation period in 2026, including updated coding guidelines, crosswalk tools from global to itemized codes, specialty-specific webinars, and payer outreach to ensure consistent interpretation. CMS and major commercial payers have indicated they will align their policies with the new CPT framework, though detailed payment policies will be released later in 2026.
The change is expected to affect millions of deliveries annually in the U.S., with particular implications for Medicaid (which covers ~42% of births) and commercial plans. Long-term, the AMA believes the modular structure will better support innovation in maternity care delivery models and outcome-based reimbursement approaches.
“Maternity care has evolved significantly over the past 30 years, yet our coding structure remained largely unchanged. Moving to itemized reporting will better reflect modern practice, improve payment accuracy, and support higher-quality, more personalised care for mothers and babies.”
By
HB Team
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