Payment for Obstetric Services

Changing the Global Obstetric Codes

• Why did ACOG advocate for the deletion of the global obstetric codes?

  ACOG primarily sought to address strong feedback from members that global OB codes led to unsustainable reimbursement and significant administrative burden. This change would allow a transition to codes that:

  • Align with clinical guidelines and reflect current obstetric practice
  • Reduce challenges with payment collection when patients transfer care or require more complex coding
  • Minimize issues with incorrect copay collection or payment reductions by payers
  • Improve data availability for risk adjustment, research on comorbid conditions, and maternal outcomes
• What role will ACOG play in this transition?

  AMA owns the copyright, trademarks, and all rights to the CPT code set. ACOG is working with the AMA to bring members all available information as soon as we have it and to develop educational resources to support ACOG members throughout this transition.

• What improvements will the new codes bring?

  ACOG believes the new codes will allow for several improvements:

  • Easier transfers regardless of when they occur (for example, if a patient is transferred during labor)
  • Support for rural health care by allowing facilities to bill for each service performed, including labor management, improving financial stability
  • The ability to account for longer labors that result in vaginal deliveries when billing by calendar day
  • Generation of a richer dataset to study and improve maternal health outcomes, including visit complexity, postpartum follow-up, and length of labor

Transition to the New Codes

• Why should I use E/M codes in 2026 when the new codes go into effect January 1, 2027?

  Services will be billed separately using existing E/M codes and new labor and management and delivery codes. Using the E/M codes beginning in 2026 will account for visits with patients whose care will extend into 2027, ensuring a smoother transition for ob-gyns. For example, according to the visit schedule, patients who come to their first antepartum visits (around 8–10 weeks gestation) will likely present for less than four visits in 2026 and deliver in 2027, when there will no longer be global codes to be billed for those circumstances.

• Is using the E/M codes for antepartum care inconsistent with CPT guidelines?

  No. Currently, according to the CPT Professional Editions, when a health care professional sees a patient less than four times, it is appropriate to use E/M codes. Several Medicaid plans have already unbundled the global code and use E/M codes for every visit.

• What if I see the patient for four or more times?

  Check with your payer about their transition policy. You can use codes 59425 and 59426 for four to six antepartum visits and seven or more antepartum visits, as they will be available in 2026, but they will be deleted in 2027.

• If I use E/M codes for antepartum care in 2026, how would I bill the delivery in 2027?

  The new code set will include separate labor management and delivery codes. Bill for postpartum care using the appropriate E/M codes.

E/M Documentation for Pregnancy

• Pregnancy is not a “problem.” How do I select the “number or complexity of problems” for the E/M code?

  ACOG recommends that for the purposes of E/M coding only, pregnancy should be considered “One or more chronic illnesses with exacerbation, progression, or side effects of treatment” due to the inherent complexity of treating the pregnant person and fetus simultaneously. This recommendation aligns with a 2023 presentation delivered by the AMA prior to the development of the new codes.

• If pregnancy is considered “one or more chronic illnesses with exacerbation, progression, or side effects of treatment,” is every visit a moderate level?

   No. For the one category, it is likely that the problem is a moderate level. Documentation should support the selection for each column (ie, problem, data, risk).

Payment

• Will I need to collect a copayment from my patient for every prenatal visit?

  You will not need to collect copayment from patients on plans that are required to adhere to the ACA statute (which is about 93% of all commercial health plans) for prenatal visits and screenings, as they are considered preventive. Some grandfathered plans and exempted plans may require a copayment; you should check with the plan and be sure to inquire if it is ACA exempted. Only those exempted from ACA may collect a copayment for prenatal care services.

• How will these new codes affect patient cost? Will their deductibles increase?

  Health plans, employers, and patients all have an impact on what the deductibles will be. As there are more than 900 health insurance companies offering more than 5,500 plan variations, it is not possible to predict what a patient’s deductible will be. Plans subject to ACA rules cannot charge a copayment for prenatal visits or screenings; however, there are currently charges for labor, delivery, and other services not considered preventive care.

• Can I wait until the end of the pregnancy to bill insurance?

  Timely filing requirements will apply; you should bill the E/M visits on a timely basis to avoid penalties and reductions in payment. One of the purposes of redesigning obstetric payment was to allow ob-gyns to bill and collect payment from insurers throughout the pregnancy, so you should not need to wait to bill.