Maternity Care Coding 2027: Business response

In part one of this four-part collection, we reviewed what’s altering with the American Medical Affiliation’s (AMA) sweeping modifications to maternity care coding efficient January 1, 2027.

For the primary time in a long time, prenatal visits, supply, and postpartum care will now not be bundled underneath a single code because the AMA seeks to make sure higher visibility into the person companies supplied all through a being pregnant.

On this installment, we’ll take a better have a look at the opposing views on response to those modifications between the Facilities for Medicare & Medicaid Providers (CMS) and the American School of Obstetricians & Gynecologists (ACOG), in addition to the added complexities of state-by-state variance with Medicaid.

Misalignments

In July of this yr, CMS proposed a possible twin billing methodology and requested suggestions on the creation of 15 new Medicare-specific HCPCS G-codes. ACOG expressed its opposition, and Health plans are left needing to adjust to the 2027 maternity code restructuring whereas ready for change as federal and state necessities are finalized.

CMS

On July 14, 2026, CMS launched its proposed 2027 Medicare Doctor Charge Schedule, together with proposed valuations for the brand new maternity CPT codes. On the identical time, CMS requested public touch upon the potential creation of 15 Medicare-specific HCPCS G-codes that may protect the standard world maternity cost mannequin for Medicare claims.

If finalized, the proposal may lead to two maternity billing methodologies working concurrently:

• The encounter-based CPT framework utilized by some payers
• A worldwide Medicare framework supported by HCPCS G-codes

This chance has generated important trade dialogue and debate.

ACOG

ACOG helps the brand new maternity CPT codes however has urged CMS to not create a separate set of Medicare G-codes, expressing considerations that sustaining each the brand new encounter-based construction and the legacy world mannequin would require suppliers and payers to handle a number of billing methodologies. ACOG has additionally warned {that a} dual-system strategy may improve administrative complexity and create variation in how maternity companies are reported throughout payers.

ACOG’s response raised concern that separating sufferers in line with insurer necessities may contribute to disparities in entry to and high quality of obstetric care. The CMS public remark interval ended September 14, 2026, and last steerage could have an effect on how Medicare maternity companies are reported and reimbursed starting in 2027.

Medicaid variance by state

Medicaid provides one other layer of complexity. State packages could undertake totally different tips, which suggests Health plans should consider the maternity modifications throughout particular person markets and contours of enterprise moderately than deal with implementation as a single nationwide configuration. As CMS, AMA, ACOG, and state packages proceed to form implementation steerage, Health plans want an strategy that helps the authorised 2027 CPT code set whereas remaining versatile sufficient to accommodate last federal and state necessities.

Remaining ideas

The 2027 maternity coding modifications are transferring ahead, however the potential for totally different Medicare, Medicaid, and business payer approaches creates important implementation uncertainty. Cotiviti will proceed to report on the newest developments for this new encounter-based framework. Partly three of this collection, we’ll have a look at the affect these modifications have on Health plans.