Payment for Obstetric Services

In This Section

In tandem with ACOG’s newly released clinical guidance, Clinical Consensus 8: “Tailored Prenatal Care Delivery for Pregnant Individuals,” ACOG’s Committee on Health Economics and Coding along with the American Medical Association revised the Current Procedural Terminology (CPT) codes to delete the global obstetric codes and create a new code set for maternity care services. New codes are going into effect on January 1, 2027.

ACOG recommends that health plans begin the transition from the global obstetric payment by using the Evaluation and Management (E/M) codes (CPT 99202–99499) without limitations or preauthorization requirements for antepartum visits, as this will be the standard beginning in 2027. This transition should occur no later than September 1, 2026, to avoid any undue administrative burdens and incorrect billing. It is recommended that the HCPCS modifier “TH” be appended to the E/M code to differentiate the visit as maternity care.

The current delivery-only codes (59409, 59514, 59612, and 59620) include labor management from the time the patient is admitted to the unit, delivery, and completion of the postpartum orders and birth certificate. Services provided at or near the point of delivery, such as long-acting reversible contraception, should be separately billed.

Additional Resources

Payment Advocacy for Obstetric Services
Payment in Practice: The Podcast!
American Medical Association (AMA) CPT Webinar, A Health Plan Primer: Previewing the CPT 2027 Restructure for Maternity Care Services
Current Procedural Terminology and Relative-Value Scale Update Committee
Statement of Policy: Payment for Obstetricians and Gynecologists
Payer Initiatives

ACOG will also be hosting several courses to prepare members and their office staff on this transition, including at each Annual District Meeting and at our November 2026 Payment in Practice – In-Person session in New Orleans, Louisiana.

For any questions, please reach out to the Payment Advocacy & Policy Portal!

Frequently Asked Questions for Payers and Policy Organizations

Changing the Global

There are several problems that ACOG was seeking to solve by changing the global obstetric codes, the most important being that in surveys and messages in the Payment Advocacy & Policy Portal, members were asking for the global to “go away.” Other reasons included that the globals were inconsistent with clinical guidelines, the current practice of obstetric care, the difficulties of collecting payment when patients transferred care, more complex patients, issues with payers collecting copayment incorrectly or cutting payments if certain measures were not met, and the lack of data we had as a profession to use for risk adjustment and research for comorbid conditions and maternal outcomes.

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ACOG believes the new codes will allow for easier transfers regardless of when they occur, even during labor, and that it will lift up rural health care. Additionally, the ability to bill per calendar day for labor management will assist with longer labors that result in vaginal deliveries. The ability to collect the number of visits and the complexity of those visits, along with follow-up postpartum visits and the length of labor, will provide a rich new dataset to study and improve maternal health outcomes.

Transition to the New Codes

The new codes include labor management and delivery services billed separately and the global OB codes will be deleted for use January 1, 2027. Antepartum and postpartum services will be billed using the E/M services currently used for all E/M services and consistent with CPT guidelines. According to the visit schedule, patients who come to their first antepartum visits (around 8–10 weeks gestation) will likely be seen less than four visits in 2026 and therefore there are no global codes that can be billed for those circumstances. They will deliver in 2027 when the codes are deleted.

E/M Documentation for Pregnancy

Payment

It depends. For plans that are required to adhere to the ACA statute (which is about 85% of all commercial health plans), prenatal visits and screenings are preventive and copayments are not collected. There are some grandfathered plans and exempted plans that may require a copayment; you should check with the plan and be sure to inquire if they are an ACA-exempted plan. Only those exempted from ACA may collect a copayment for prenatal care services.
That is difficult to say. Health plans, employers, and patients all have an impact on what the deductibles will be. As there are over 900 health insurance companies offering over 5,500 plan variations, it is not possible to predict what a patient’s deductible will be. We can say that those plans subject to ACA rules cannot charge a copayment for prenatal visits or screenings. At this time, there are charges for labor, delivery, and other services not considered preventive care.

Tailored Visit Schedules

Guidelines are effective only if used. Several institutions across the United States have already begun to implement this model of prenatal care. Further work is needed to define the facilitators, barriers, and most effective strategies for implementing person-centered, tailored prenatal care. Implementation strategies should carefully consider how new models affect the patient’s experience of care. Although tailored prenatal care may improve operational efficiency and access to care, research should ensure it does not do so at the expense of patients, particularly those historically marginalized by the health system. Tailored prenatal care is well aligned with other national efforts to improve pregnancy outcomes through fostering a more positive patient care experience and patient autonomy.

Contracts with health insurers should also be considered. If your practice is enrolled in an Alternative Payment Model, there may be billing, documentation, and quality metrics that are required. Understand your agreements with health insurers, and for assistance with policies, go to the Payment Advocacy and Policy Portal.
Screening for medical and social risk factors and then using shared decision-making to guide prenatal care can begin as soon as a patient knows they are pregnant. A team-based approach to addressing social and structural drivers of health can also be started immediately with an assessment of available team members and community resources. Customization of prenatal care through shared decision-making can be started with average-risk patients to allow individuals to have prenatal care that meets their medical needs and personal preferences. Care tailoring should be continuously revisited during pregnancy to account for changing risks and preferences.

New codes for billing are anticipated on January 1, 2027.

Social Needs Screening and Management

Obstetric care professionals can consider aligning outpatient efforts to address unmet social needs with the inpatient screening recommendations put forth by the Joint Commission and the Centers for Medicare & Medicaid Services. Larger health care systems, hospitals, and state agencies should support changes in legislative policy to improve resources addressing social and structural determinants of health. Supportive policy solutions, including public infrastructure and payment for care coordination, are needed.

Diagnostic codes for the claims are available through the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) in Chapter XXI, Factors influencing health status and contact with health services, Z55-Z65.

Telemedicine and Home Monitoring

Telehealth can take many forms. For some individuals and prenatal visits, cellphone audio may be sufficient. Other visits may require video or internet access. Some individuals may be able to ask family members to assist with access. Community organizations may have useful resources for assistance (eg, phone cards, internet access). For example, some libraries facilitate access to high-speed internet and create private areas specifically for telehealth.

A team-based approach may be needed to facilitate access to needed resources for tailored prenatal care. Often, individuals with barriers to telehealth also have difficulty accessing in-person care. Assistance and care adjustment can improve the overall uptake of beneficial perinatal services and community resources.

In 2025, new CPT^® codes were introduced for billing telehealth visits, delineated by:
- Audio-video synchronous telehealth (98000-98007)
- Audio-only synchronous telehealth (98008-98015)
- Brief (5-10 minutes) synchronous telehealth (98016)
For more information, visit the Payment Advocacy and Policy Portal.
The cost of home devices remains a barrier to self-monitoring for many individuals, and future policies are needed to improve inequitable access. Some states have enacted legislation guaranteeing access to blood pressure monitors for patients. Visit ACOG’s Tailored Prenatal Care Resource website for further information. To report issues with coverage and payment to ACOG, visit the Payment Advocacy and Policy Portal.