As you may know, the Current Procedural Terminology (CPT) Editorial Panel, along with the American College of Obstetricians and Gynecologists and other governing bodies, has approved a significant restructuring of maternity care services codes for the CPT 2027 code set.
Effective Jan. 1, 2027, these industrywide changes to CPT coding will alter how maternity services are reported and billed to better reflect the increasingly complex reality of modern obstetric practice, recognizing that care is often provided by multiple clinicians in different health systems and practices throughout pregnancy.
Once implemented, we expect that these changes will apply consistently across all Point32Health products.
Fundamental change in maternity coding approach
Current maternity coding is based largely around bundled or “global" billing. This approach, which no longer reflects modern, team-based obstetric care delivery, is being replaced by a coding structure with a focus on reporting care more granularly at the service level.
Under the new CPT maternity coding framework:
To better support evidence-based labor and postpartum care, and to facilitate improved transparency, data quality and measurement, maternity care will be organized into the following four defined phases, each with specific coding expectations: antepartum, labor management, delivery, and postpartum.
Point32Health’s initial focus on antepartum care
Point32Health is actively working toward implementation of the new maternity CPT coding structure. We will communicate to our provider network before any required changes are made to billing processes. Our priority is to ensure that our provider partners are informed, familiarized, and supported in advance of any new requirements or changes in experience.
As an initial step in our multi-phased implementation approach, we’re focusing first on billing for antepartum care. Antepartum care is now recommended as a tailored care approach that includes a patient-centered plan of care with a modified visit schedule that incorporates telehealth visits and is adjusted according to the medical and health related social needs of the patient, instead of the traditional thirteen antepartum visits.
For dates of service beginning Aug. 1, 2026, antepartum visits provided in 2026 should be reported using the CPT coding below, as applicable. The reporting is dependent on the number of visits in the calendar year.
This coding guidance will change in 2027 as CPT codes 59425 and 59426 will be deleted and antepartum visits will be reported per encounter with the appropriate E/M procedure code that is based on the location of the patient. However, from now through the remainder of 2026, please adhere to the coding practice detailed above.
Future maternity coding updates
Additional communications will be shared as Point32Health’s implementation planning continues, including operational details, billing guidance, and any updates to the Obstetrics/Gynecology Payment policy.