Revenue Cycle Insider

Say goodbye to bundled procedures and hello to individual service codes.

Effective Jan. 1, 2027, the CPT^® code book will see a monumental restructure of the Maternity Care Services section. For decades, obstetric medical coding relied on “global maternity packages” — single omnibus codes that bundled antepartum care, delivery, and routine postpartum care into a single billing entity.

In 2027, the global maternity packages will be deleted, along with their delivery-only and postpartum-only counterparts.

In their place, the AMA has mandated a component-based reporting model. Providers must now document and explicitly report each stage of maternity care as individual, independent functional services. This shift guarantees modern team-based obstetric care, improves transparency, enhances data quality and measurement, and supports evidence-based labor and postpartum care.

Keep reading to learn more about this shift in reporting maternity services.

Understand the Reason for the Change

The current CPT^® code structure has remained largely unchanged for over 30 years, yet maternity care has evolved dramatically during that time. Today’s clinical environment reflects greater patient complexity and new patterns of care that the existing codes fail to capture. Key drivers include:

• Escalation of care from rural hospitals to tertiary centers
• Longer and more complex labor patterns, with greater use of induction to safely reduce cesarean (C-section) delivery rates
• Heightened focus on hemorrhage, cardiovascular disease, and maternal mental health to reduce morbidity and mortality
• Shifts in patient demographics and provider practice models
• Expanded use of data and information systems to better track care provided
• Integration of telehealth and e-services

The table below shows which codes will be deleted from the CPT^® code book in 2027:

Here’s How to Report Antepartum Care in 2027

Antepartum care encompasses the comprehensive medical management of a pregnancy prior to the physiological onset of labor or permanent surgical interruption. Under the 2027 framework, you’ll document all prenatal visits, whether routine or high risk, utilizing evaluation and management (E/M) codes, examples of which include:

• New patient: 99202-99205 (Office or other outpatient visit for the evaluation and management of a new patient, ...)
• Established patient: 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …)

Pregnancy confirmation: When a patient presents for an initial encounter to confirm pregnancy, the clinician must code the service using the appropriate E/M code for that specific setting.

Auxiliary professionals (Non-E/M): For specialized care provided by auxiliary qualified healthcare professionals (QHPs) who are legally restricted from reporting standard medical E/M codes, code directly to dedicated functional lines, such as:

• Genetic counseling: 96041 (Medical genetics and genetic counseling services, each 30 minutes of total time provided by the genetic counselor on the date of the encounter)
• Medical nutrition therapy: 97802-97804 (Medical nutrition therapy …)

Initial site of service separation: If a pregnant patient is admitted to a facility for acute antepartum monitoring or complications (excluding active labor management) straight from an initial site of service, such as the clinic or the emergency department (ED), the services at the initial site are separately reportable. According to the 2027 CPT^® Maternity Care Services guidelines, you’ll append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the initial site’s E/M code to denote a significant, separately identifiable E/M service by the same professional/group on the same date.

Antepartum procedures and fetal invasive services: You may separately report antepartum and fetal invasive procedures from prenatal E/M visits, and you can also separately report any diagnostic imaging services (for example, obstetrical ultrasound evaluation of the fetus[es] including maternal pelvis and placenta) in addition to antepartum E/M visits.

Antepartum procedure and fetal invasive service codes include:

CPT^® will move codes 59320, 59325, 59412, 59866, and 59871 from other subsections to the antepartum procedures and fetal invasive services subsection in 2027.

Learn How to Report Labor Management

Labor management represents integrated clinical decision-making to continually assess, support, and balance the physiological well-being of the parturient and the fetus(es). This encompasses managing active labor progression and any concurrent maternal/fetal medical conditions or emerging complications, such as gestational diabetes, preeclampsia, abnormal fetal heart rate tracings, or labor dystocia.

Effective January 1, you’ll use the following codes to report labor management:

Inclusions: Labor management codes include routine interim physical examinations, collection and interpretation of continuous/intermittent physiologic data (for example, partograms, maternal vital signs, and pulse oximetry), and standard methods for the induction or augmentation of labor, which means you cannot separately report the services.

Labor management code guidelines are similar to E/M services, in that the code restrictions include:

• Face-to-face visit: All labor management codes strictly require a documented face-to-face encounter with the parturient by the reporting provider.
• Daily calendar cap: These codes are restricted to a maximum of once per calendar date. You must aggregate and report multiple separate encounters over a single calendar date by the same provider or within the same group practice/exact specialty as a single labor management service using the highest level of complexity reached on that date.
• Continuous visits: A continuous bedside visit that spans the midnight transition of two dates is considered a single, unbroken service. You must report it as a single unit on either the initial or subsequent date, but never on both.
• Cross-coverage: If a provider is on call or cross-covering, the encounter is classified exactly as it would have been by the primary attending. Advanced practice registered nurses (for example, certified nurse midwives) and physician assistants (PAs) working in tandem with physicians are considered as practicing within the exact same specialty configuration.
• Multi-gestation rule: For multiple gestations (for example, twins, triplets), report labor management exactly once per calendar date, regardless of the number of fetuses being monitored.
• Initial vs. subsequent day: Initial day codes include the E/M workload of facility admission. If labor crosses multiple days, report subsequent day codes for additional dates up until the delivery date. You cannot assign subsequent day codes on the date that the initial labor management service begins. Initial day labor management can only be reported once per stay, unless the patient is transferred to a completely new facility or a specialist of a completely different subspecialty assumes care due to extreme medical necessity.
• E/M and labor management on same day: Providers are strictly prohibited from reporting standard facility inpatient/observation E/M codes on the same date as labor management codes when the same provider or group practice is managing both the general hospital care and active labor.

Labor management factors: The selection between straightforward (59080, 59082) and complex (59081, 59083) tracking is driven by the medical decision making (MDM) and maternal/fetal clinical pathology. The labor duration doesn’t dictate complexity, unless the provider documents a clinical diagnosis of prolonged labor. If a patient starts as straightforward but escalates into complex labor on the same date, report only the complex code.

The levels of labor management are defined by the following factors:

VBAC/TOLAC complexity: Always code complex labor management (59081 or 59083) if the patient has a history of a previous C-section and is attempting a trial of labor after cesarean (TOLAC) for a vaginal birth after cesarean (VBAC), even if the labor progresses normally and has no complications.

Determine How to Code Delivery Care

Delivery care officially commences when active labor is clinically complete. This is defined as when the presenting part of the fetus is visible and firmly rimmed by the vaginal introitus, or when labor is permanently interrupted (for example, the provider diagnoses an arrest of labor and makes an immediate clinical decision to transition to an emergency cesarean delivery). Delivery care codes encompass the active management of both the parturient and the fetus(es) during extraction.

In 2027, you’ll report vaginal deliveries with the following new codes:

If the patient experiences an episiotomy or laceration during delivery, you’ll assign one of the following new codes to report the repair:

Use the following new codes to report cesarean deliveries in 2027:

Coding C-section deliveries requires careful attention to important guidelines. If a vaginal delivery is actively attempted but clinical failure occurs resulting in an immediate transition to a cesarean delivery, you’ll report only the appropriate C-section delivery code.

If the provider decides to perform an unscheduled or unplanned C-section delivery for a laboring parturient, the delivery begins when the decision is made. You may report the C-section delivery (primary or repeat) code with the labor management code. However, “When a patient presents for a scheduled or planned cesarean delivery and is not in labor, a labor management code is not reported,” according to the 2027 CPT^® guidelines.

This means you can separately report an E/M service, such as an initial or subsequent hospital inpatient or observation care service, on the same date as a planned or scheduled primary C-section delivery that occurs without labor. Conversely, the initial or subsequent hospital inpatient or observation care services are included in repeat C-section delivery because the delivery is usually a planned event without labor, so you cannot report the E/M services separately on the same date as the delivery.

Immediate postpartum care bundling: Postpartum clinical management performed on the same date as the delivery is bundled into the delivery care service line and is not separately reportable. Same-day facility discharge codes (99238-99239 [Hospital inpatient or observation discharge day management …]) are strictly prohibited if executed on the same date as delivery.

Familiarize Yourself With New Maternal Postpartum Care Guidelines

Maternal postpartum care under the CPT^® 2027 framework encompasses ongoing physical, psychological, and systemic assessments tailored to the recovering patient. Similar to antepartum care, post-delivery recovery services have been completely unbundled from global delivery packages and are tracked exclusively through E/M codes based on the timing and location of the service. Here’s a look at some of the new regulations:

• Inpatient postpartum rules: Inpatient maternal postpartum evaluations performed on a date other than the date of delivery are reported with an E/M code, such as the following:
  • 99231-99233 (Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination …)
  • 99291 and +99292 (Critical care, evaluation and management of the critically ill or critically injured patient …)
  • 99238-99239

• Same-day coding ban: You cannot report standard E/M codes, combined admission/discharge codes, or dedicated discharge codes for maternal postpartum care if the service takes place on the same date as the delivery, as same-day recovery care is fully bundled into the delivery service line.
• Outpatient postpartum rules: For routine or complicated outpatient postpartum encounters occurring subsequent to delivery care, providers must report the corresponding outpatient E/M service code.
• In 2027, you’ll report 59623 (Uterine tamponade (eg, balloon, catheter, vacuum, packing material)) if a provider encounters severe postpartum hemorrhage and places an intra-uterine tamponade (for example, a Bakri balloon, catheter, vacuum, or uterine packing material). Code 59623 is strictly restricted to mechanical or physical tamponade insertion. You cannot report 59623 for pharmacological management of postpartum hemorrhage, as pharmacological stabilization is considered part of standard delivery/recovery care.

Important: Remember that you must bill all services provided to the newborn baby completely independently from the maternal chart.

Stay tuned to Revenue Cycle Insider as we continue to examine the upcoming 2027 CPT^® Maternity Care Services code and guideline changes.

Aniket Sanjay Bagate, CPC, CEMC, Pune, Maharashtra, India