In the August issue of Insights and Updates for Providers, we shared information about the industrywide changes to the structuring of maternity care services codes coming Jan. 1, 2027, and Point32Health’s plan to consequently apply maternity coding changes consistently across all of our products. 

We’re offering additional details about updates to our Obstetrics/Gynecology Payment Policy, which will be effective for dates of service on or after Jan. 1, 2027 and reflect the CPT 2027 code set for maternity care services. 

The policy identifies the current coding guidance in effect prior to Jan. 1, 2027, as well as the billing and coding guidance which will apply on or after Jan. 1, 2027. The new CPT maternity coding framework is segmented into four defined phases:

  • Antepartum care – Includes the management of pregnancy prior to the onset of labor.
  • Labor management – Involves decision making to assess, support and balance the well-being of a pregnant person. Labor management codes are used to report initial and subsequent day labor management for the pregnant person admitted to the facility.
  • Delivery care – Begins when labor is complete or interrupted. Delivery care includes management of the mother and the newborn(s).
  • Postpartum care – Includes ongoing assessments and is reported on a calendar date other than the delivery date. 

Point32Health’s updated maternity coding supports guidelines from the American Medical Association, which are not yet finalized but were made available early to assist providers in preparing for the significant revisions to this section of the CPT code set.

Maternity coding is changing; maternity care is not

Please keep in mind that members will continue to have access to the same maternity care they receive today. What is changing is the billing process and the way these services are reported and processed. 

The changes 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. 

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. 

Reminder: antepartum care delivered in 2026

As a reminder, when antepartum care starts in 2026 with an expected delivery in 2027, 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. 

  • 59425 (4-6 visits)  
  • 59426 (7 or more visits) 
  • E/M codes (fewer than 4 visits)

This coding guidance will change in 2027 as CPT codes 59425 and 59426 will be deleted and antepartum visits will need to be reported per encounter with the appropriate E/M procedure code that is based on the location of the patient. 

Refer to Point32Health’s updated Obstetrics/Gynecology Payment Policy for more information on our 2027 maternity care coding structure. 

(Consistent with Maine regulations, a redlined version of this policy is also posted temporarily.)