CPT 2027 Maternity Care Codes: Key Changes, Industry Debate, and Coding Impact

Significant updates to maternity care services coding are set to take effect with the release of CPT® 2027, causing considerable discussion among healthcare providers, coding professionals, and policy makers—including the Centers for Medicare & Medicaid Services (CMS). These changes represent the first major overhaul in over 30 years and are designed to better align coding practices with current standards of care and clinical realities.

Understanding the Shift: Why Are CPT® Codes for Maternity Care Changing?

For decades, maternity care services have been reimbursed under a global package model referred to as the MMM global period, which bundled all phases of maternity care—antepartum, labor management, delivery, and postpartum—into a single payment code. However, the American Medical Association (AMA), after extensive consultation with clinical experts and review of contemporary data, has determined this model no longer accurately reflects the complexity and team-based nature of modern maternity care.

What’s Motivating the Change?

• Increasing Care Complexity: Obstetric care today involves more sophisticated interventions, multidisciplinary teams, and individualized plans than when the original codes were created.
• Improving Data and Transparency: The new coding structure increases granularity, supporting better data collection and transparency for quality measurement and outcomes tracking.
• Aligning with Evidence-Based Practice: The update aims to reflect current guidelines and best practices in obstetric care, including a more tailored approach to prenatal and postpartum visits.

CPT® 2027: What’s New for Maternity Care Coding?

Effective January 1, 2027, the familiar bundled global codes for maternity care will be deleted. Instead, each phase of maternity care—antepartum, labor and delivery, and postpartum—will be reported using separate, newly defined or revised codes.

Key Changes Include:

• Deletion of 17 Codes: Outdated codes tied to the global approach will be removed.
• Addition of 12 New Codes: Focused on more specific, phase-based reporting.
• Revision of 6 Codes: Updated to reflect new clinical realities and documentation needs.
• Creation of New Subsections and Guidelines: Providing clearer guidance for coding professionals and healthcare providers.

As outlined in Table A-D2 of the 2027 Medicare Physician Fee Schedule (MPFS) proposed rule, these changes are designed to streamline documentation and payment while capturing the true scope of services provided.

How Will Providers and Health Plans Be Impacted?

This transition from a global maternity package to individual service codes is expected to have far-reaching implications across the entire healthcare system:

• For Providers: Greater specificity in coding may require adjustments in billing workflows and electronic health record (EHR) templates.
• For Health Plans: Insurers will need to update claims processing systems, adjust payment structures, and potentially revise network contracts.
• For Patients: The move could enhance transparency, allowing patients to better understand what services they receive and how those services are billed.

CMS’s Dilemma: Adopt CPT® 2027 or Create New G Codes?

In the 2027 MPFS proposed rule (published in the Federal Register on July 16), CMS acknowledges the magnitude of these changes and expresses concerns about potential disruption to established clinical practice patterns. As a result, CMS is considering two main options:

• Option 1: Adopt the new CPT® 2027 codes for maternity care, with minor adjustments to the valuation methodology used by the AMA.
• Option 2: Develop a set of 15 new HCPCS Level II G codes that would preserve the existing global code structure for Medicare beneficiaries.

CMS is seeking public comment on which route to take, underscoring the high stakes involved for all stakeholders.

CMS’s Concerns

Quoting the proposed rule, CMS states, “We have concerns that our adoption of the new [CPT®] codes would be disruptive based on how the longstanding existing code structure is currently accounted for in clinical practice patterns.” This highlights the balancing act CMS faces: modernizing payment systems without causing unnecessary upheaval for providers and beneficiaries.

Reimbursement and Valuation: The RVU Debate

At the heart of this discussion is how much Relative Value Units (RVUs) should be assigned to each new code—a critical factor in determining provider payment.

• AMA’s Approach: The AMA’s RUC based RVUs for the new codes on 12 prenatal E/M visits bundled into the traditional codes (59400, 59510, 59610, 59618).
• Evolving Clinical Guidelines: The American College of Obstetricians and Gynecologists (ACOG) now recommends an average of eight visits for low-risk pregnancies and 13 visits for higher-risk cases.
• CMS’s Proposal: To reflect these updated guidelines, CMS proposes to remove four E/M visits from the utilization estimate, reallocating those RVUs to labor and delivery codes. This would decrease RVUs for antepartum and postpartum care, but increase labor and delivery RVUs by 15%.

The proposed work RVUs for the new G codes are detailed in Table A-D3 of the rule.

Stakeholder Perspectives: ACOG Speaks Out

The American College of Obstetricians and Gynecologists (ACOG) has voiced strong opposition to CMS’s idea of creating new G codes, calling the proposal “misinformed and based on incorrect statements.” In a recent podcast, ACOG’s policy team leader, Lisa Satterfield, highlighted several concerns:

• Dual Coding Systems Create Chaos: Allowing both new CPT® codes and G codes to coexist would let health plans choose which system to use, resulting in “chaos and instability” for providers and patients alike.
• Undermining Reform Efforts: ACOG has invested years in advocating for a uniform, modern coding system to improve maternity outcomes and data quality.
• Provider Sentiment: Surveys of ACOG members indicate overwhelming support for eliminating the global codes in favor of the new CPT® structure.

Satterfield notes, “We don’t need two concurrent coding systems at the same time,” emphasizing the need for consistency and clarity across all payers.

The Precedent: CMS and Parallel Code Systems

It’s important to note that CMS has, in the past, created HCPCS Level II codes for Medicare reporting even when CPT® codes exist for the same services. This approach is not unprecedented, particularly when CMS seeks to bundle services or maintain payment structures unique to Medicare beneficiaries. However, the introduction of parallel code systems is rarely without controversy.

What Should Stakeholders Do Now?

CMS is actively soliciting feedback from the healthcare community on whether to adopt the new CPT® codes or establish a parallel G code system for maternity care services. Stakeholders are encouraged to submit comments, especially on:

• The valuation and payment of maternity care codes under the MPFS
• The potential impact of concurrent coding systems on clinical practice, revenue cycle management, and patient care
• Alternative solutions to ease the transition and minimize disruption

Key Takeaways for Providers, Coders, and Policy Makers

• Major Coding Overhaul: Maternity care coding is undergoing its largest transformation in decades, with a shift from bundled global codes to phase-based, granular reporting.
• CMS Is Weighing Its Options: The agency may either adopt the AMA’s CPT® changes or create new G codes, with significant implications for reimbursement and workflow.
• Stakeholder Input Is Essential: The outcome will be shaped by feedback from clinicians, coders, payers, and patient advocacy groups. Engaging in the rulemaking process is vital.
• Stay Informed: As the final rule approaches, continue to monitor updates from CMS, the AMA, and organizations like ACOG and AAPC for the latest guidance and implementation tips.

Conclusion

The CPT® 2027 changes to maternity care services coding represent a milestone in aligning reimbursement models with the complexities of modern obstetric care. While there is consensus on the need for reform, the path forward—whether via adoption of CPT® codes or the creation of new G codes—remains under debate.  Stakeholders have a unique opportunity to influence this decision by providing input to CMS. The coming months will be critical in shaping the future of maternity care coding and ensuring that payment models support the highest standards of care for mothers and infants alike.

Source: CPT® 2027 Maternity Care Codes Spark Debate