Payment for Obstetricians and Gynecologists

The American College of Obstetricians and Gynecologists (ACOG) is committed to ensuring fair and equitable payment that sustains obstetric and gynecologic practices, provides equitable coverage and payment for all services provided by obstetrician–gynecologists, reduces administrative burden, and protects the physical and emotional health and well-being of physicians.

ACOG calls for quality health care appropriate to every person’s needs throughout their life span. It is critical and consistent with the mission and vision of ACOG that all people are provided with adequate and affordable health care coverage. To ensure ongoing access to the essential care provided by obstetrician–gynecologists, payment from public and private payers must sustain physician practices and reflect the intimate, expert care provided to a complex patient population.

Current payment methodologies, especially those using the bundled global maternity codes for obstetric services, no longer reflect the care occurring today. These clinical changes exist in the antepartum visits; the use of telehealth and home monitoring; the transfer from rural health facilities to tertiary care facilities; the increase of labor inductions and time in labor to decrease cesarean deliveries; and the need for additional postpartum monitoring for hemorrhage, cardiac conditions, and mental health conditions. Furthermore, widespread practice models now divide these stages of pregnancy care between differing unrelated health care professional teams. It is not realistic to attribute the care of a pregnant person to a single physician or small associate group practice.

There is currently wide variability in the reporting of maternity care services on claims to insurers. Several Medicaid programs require the global maternity codes; others use per-visit billing; and some use a combination of both options, making it nearly impossible to normalize data sets. Those payers that have strictly used the global maternity codes do not have large-scale administrative data regarding the number of visits, the medical decision-making for each visit, or the time and complexity of labor management. This has left a dearth of data available for appropriate, accurate risk adjustment calculations needed to develop alternative payment models. 

ACOG supports payment methodologies that provide obstetrician–gynecologists with the necessary resources to offer individualized, patient-centered care and simultaneously collect data related to the number of visits, the quantity of medical and nonmedical services, and time and complexity in labor management, which are needed to better understand the care provided. However, Current Procedural Terminology® code development is a long-term solution that takes years to achieve. Until new codes are developed, ACOG supports insurer billing policies that include …

• Separate billing and payment for ancillary and supportive services, including but not limited to the administration and interpretation of screening (eg, depression, health-related social needs, or social determinants of health), counseling services (eg, genetic, vaccine, nutrition), group prenatal care, education for self-administered monitoring (eg, blood pressure, weight, glucose levels), and other services that were not accounted for in the development of the global maternity codes
• Adopting modifiers that may be used with existing codes that recognize the complexity of medical decision-making specific to obstetrics care and the evaluation and management (E/M) of two unique patients
• Using inpatient E/M codes for labor management up until the time of delivery, allowing multiple hospitals and health care professionals to bill for health care professional transitions during the episode of care, especially during multiple shifts and days of labor
• Using the delivery-only codes for the delivery and inpatient hospital postpartum visits
• Allowing multiple obstetric care professionals to bill for multigestational deliveries
• Separate billing and payment for services provided at or near the point of delivery, including but not limited to the insertion of long-acting reversible contraception and management of hemorrhage
• Separate billing and payment for ongoing outpatient management and care coordination for postpartum conditions that require additional care, such as cardiac conditions, mental health conditions, and support for health-related social needs or social determinants of health 

Approved by the Board of Directors March 2024