Payment Advocacy for Obstetric Services

Advocacy with payers will be an essential part of the success of the obstetric code transition. ACOG has contacted payers at the national level; however, it is imperative that ob-gyn offices reach out to their payer contacts and begin discussion and contract negotiations as soon as possible. Do not wait for them to reach out to you.

Contract changes are inevitable! This transition plan, which includes evaluation and management (E/M) codes, is consistent with current CPT guidance and will ease the burden on providers and plans. The content below is consistent with the information ACOG provided the payers.

Use this Toolkit for Talking to Payers

Rationale for Transitioning Using the CPT Evaluation and Management Codes

• E/M codes for antepartum services are already incorporated into existing contracts, claims processing systems, and electronic health records.
• CPT rules already exist that allow for E/M codes when only one to three visits for antepartum services are provided.
• Leveraging E/M codes allows for a defined education and transition period for antepartum services while minimizing disruption for health plans, ob-gyns, and coding staff.
• Ob-gyns are already trained in E/M coding and ACOG has established educational resources.
• Certain Medicaid programs currently use E/M codes for prenatal visits.
• This approach reduces reliance on retrospective, end‑of‑year billing for bundled prenatal care codes and mitigates the administrative burden associated with high volumes of year‑end claims.

Transitioning from Global Obstetric Payment

The first antepartum visit is typically at 8–10 weeks gestation. Based on that first visit, a typical antepartum visit schedule, and a normal gestation, patients who present for their first antepartum visit in the following date ranges will be likely use the codes listed:

1. Until May 15: Payer may use the global obstetric codes.
2. From May 15 to July 14 only: Utilize 59426 + delivery only.
3. From July 15 to Sept 1 only: Utilize 59425 + delivery.
4. Starting September 1: Transition to E/M codes.

Given these parameters, consider the following examples:

• For pregnancies with a first 10-week visit between January 1, 2026, and August 31, 2026, use the current global obstetric codes, including antepartum-only codes
• For pregnancies with a first 10-week visit on or after September 1, 2026, use the existing E/M codes for antepartum visits, as long as they total less than four encounters prior to 2027. This is consistent with current CPT guidelines.

Criteria for Transition

Starting September 1, 2026, the first prenatal visit after confirmation of pregnancy must be billed with E/M codes and the appropriate ICD-10-CM codes.

*Antepartum care is reported using appropriate evaluation and management (E/M) codes based on specific location.

Additional Resources

• Payment for Obstetric Services
• Payment in Practice 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!