Introduction: A Long-Overdue Change in Obstetric Payment
For decades, OBGYNs have been paid under a global obstetric billing model that bundles prenatal care, delivery, and postpartum services into a single payment. But what many physicians have long felt is finally being acknowledged at a national level: the global model has never truly reflected the real work, complexity, and individualized care that obstetricians provide.
Beginning January 1, 2027, this model changes completely.
The AMA CPT Editorial Panel has approved the deletion of 16 global obstetric codes, the revision of 6 codes, and the introduction of 12 new maternity care codes. The goal is simple: unbundle maternity care so physicians are finally paid for the work they actually do.
For many OBGYN practices, this may be the most positive shift in maternity care reimbursement in decades.
Why the Global OB Billing Model Is Ending
The traditional global model was built for a different era of prenatal care—one with fewer screenings, fewer chronic conditions, and far less patient counseling. Modern obstetrics looks very different.
Today’s OBGYNs manage:
- Complex maternal health conditions
- Mental health screening and counseling
- Social determinants of health
- Genetic testing and counseling
- More frequent monitoring
- Extensive postpartum follow-up
- High-risk pregnancy management
- Electronic communication and care coordination
ACOG has made it clear that the global codes no longer reflect today’s standard of care and that it is time for a model that supports accuracy, fairness, and transparency in reimbursement.
What’s Actually Changing in 2027
Here’s what we can say with certainty:
1. Global codes like 59400, 59510, and 59610 will be eliminated.
Sixteen codes will be deleted and will no longer be billable as of January 1, 2027. These include:
- 59400 (global vaginal delivery)
- 59510 (global cesarean delivery)
- 59610 (VBAC care)
- Antepartum bundles and postpartum-only codes
2. Care will shift to itemized, visit-level billing.
OBGYNs will bill prenatal and postpartum visits using E/M codes (99202–99499) with the TH modifier, signaling pregnancy-related care.
3. Delivery-only codes remain.
Codes like 59409 and 59514 will continue but will apply only to the delivery itself.
4. Labor management over multiple days will be billed with inpatient E/M codes.
This ensures fair payment when labor spans several calendar days or facilities.
5. Twins and multiples will be billed with multiple delivery units.
6. ACOG and SMFM are fully aligned behind this change.
What We Still Don’t Know
Because the new codes are confidential until the 2027 CPT Manual is released, several key details remain unknown:
- The exact new CPT codes being introduced
- Code descriptions and guidelines
- RVU values and payment rates
- How Medicaid and commercial payers will price these codes
- Whether insurers will require prior authorizations
- Documentation and frequency requirements
- Payer-specific billing rules
CMS will release much of this information in late 2026.
Why This Change May Benefit OBGYN Practices
This shift represents a major step toward equitable reimbursement.
In the traditional global model:
- High-risk patients take more time but do not reimburse more
- Complex counseling is undervalued
- Additional visits and management are absorbed into a single global fee
- Practices often lose money on complex pregnancies
The unbundled model helps practices:
1. Get paid for every medically necessary prenatal and postpartum visit.
2. Bill for extended counseling and complication management.
3. Capture RVUs more accurately and fairly.
4. Reduce disputes when multiple providers participate in the patient’s care.
5. Improve financial sustainability, especially in high-risk populations.
For practices already providing high-touch, comprehensive maternal care, this could increase overall reimbursement.
How OBGYN Practices Should Prepare Now
Even though full details aren’t published yet, there are several steps you can take today:
1. Begin documenting prenatal and postpartum visits like traditional E/M visits.
Clear history, exam, and medical decision-making will be essential.
2. Update EHR templates.
3. Train the entire clinical and billing staff.
4. Educate patients on the difference they’ll see in billing.
5. Review payer contracts ahead of 2027.
6. Start financial modeling based on your visit volume.
NatRevMD is already guiding OBGYN clients through documentation updates, EHR prep, and revenue modeling to help their practices transition smoothly.
What This Means for the Future of OBGYN Payment
This shift to an unbundled maternity care model represents a major evolution in how obstetric work is recognized and valued. While the transition will require preparation, training, and workflow adjustments, it also presents a real opportunity:
- To be paid fairly for the high-quality care you already provide
- To better align reimbursement with complexity
- To support sustainability for independent OBGYN practices
Over the next 12–18 months, the key will be staying informed and preparing your practice now, well before January 2027 arrives.
NatRevMD will continue to publish updates, guidance, and resources as more details become available.
