Starting January 1, 2027, maternity billing will move from one global bundle to more detailed CPT^© codes. For employer-sponsored group health plans, the change could bring better visibility into maternity care while raising new questions about costs, administration and the participant experience.

Why the coding model is getting an update

For decades, maternity care has often been billed as a single payment, regardless of clinical complexity. The current approach does not fully reflect modern obstetric care, and changes are needed to help physicians improve outcomes for mothers and babies, according to an American Medical Association (AMA) press release. The AMA says it is working with physicians, plans, electronic health record vendors and the Centers for Medicare & Medicaid Services (CMS) to support implementation and education before the codes take effect.

Maternity care also is not always delivered by one clinician or one facility. Patients may see multiple clinicians across practices or health systems.

What will change in 2027

The global maternity code represented nearly ten months of care in one “one-size-fits-all” payment, and those global codes will be deleted. In their place, the new codes will capture four phases of care: antepartum care, labor management, delivery and postpartum care, with separate codes for items and services in each phase.

CPT codes, in brief

Current Procedural Terminology (CPT) codes and descriptions are copyrighted by the American Medical Association. Health care providers use CPT codes to bill for services, and plans use them to determine provider payments.

How payment values are set

CMS assigns dollar values to CPT codes and updates fee structures annually. Final CMS fee schedules for the new maternity codes are not yet available but are expected in early November 2026.

What self-funded plans may see

Earlier insight, less predictability

For self-funded plans, one potential benefit is earlier visibility into maternity care. Instead of waiting for claims after delivery, plans may see activity as care happens. The new codes could give plans more information, including when a participant becomes pregnant, which could help them support prenatal care and identify delivery complications that may require follow-up, according to Dr. Daniel Halevy of Healthfirst, a member of the AMA’s CPT Editorial Panel, as reported by Healthcare Dive.

The trade-off is less predictability. WTW notes that professional maternity reimbursement may rise and cost predictability may decline, even if the overall impact on total health care spending is modest for many plan sponsors.

Cost and utilization questions

Each plan’s experience will likely vary based on provider coding patterns, use of separately reimbursable services and the risk profile of the covered population, according to WTW.

Plans with higher-risk populations could see higher utilization and spending under unbundling, with possible implications for premium setting over time, per Manatt Health.

Plans may also want to watch for more frequent billing, higher-intensity visit coding, additional tests or greater use of higher-cost providers, KFF Health News reported.

What plans may need to update

This change is not just a coding update for providers. Health plans will need to update contracts, fee schedules, claims systems, edits and vendor processes that reference deleted global codes, AMA’s FAQs noted. Plan sponsors should ask carriers and claims administrators how they are preparing, how they will report maternity claims under the new structure and whether provider contracts may be affected, Aon reported.

Plan sponsors should also expect a transition period, including coding updates, claims-processing questions and participant confusion for pregnancies that begin in 2026 and continue into 2027, Mercer notes.

What participants may notice

For participants, the change may show up mainly in how and when bills appear. The AMA has stated that the coding change is not expected to change health plan benefits or increase patient cost sharing. Still, maternity claims may be submitted throughout pregnancy rather than mainly after delivery.

The American College of Obstetricians & Gynecologists (ACOG) notes that patients in plans covering preventive services generally should not have copayments for prenatal visits or screenings. Charges may still apply for services that are not considered preventive care.

Plan sponsors may want to watch pregnancies that cross calendar-year or plan-year boundaries. Depending on plan design, deductibles and out-of-pocket maximums may reset mid-pregnancy, which could affect participant costs. Labor management and delivery are expected to be more costly than prenatal visits, but the actual impact will depend on case complexity.

Questions to ask before 2027

Before the new codes take effect, self-funded plan sponsors may want to ask carriers, TPAs and maternity vendors:

• How are contracts, fee schedules, claims systems and edits being updated for the deleted global codes?
• What reporting will be available for prenatal, labor and delivery, and postpartum claims activity?
• How will the plan identify high-risk pregnancies, care gaps and postpartum follow-up needs earlier?
• What cost impact is expected for the plan’s population, including higher-risk pregnancies?
• How could the change affect participant cost sharing, billing timing or confusion during the transition?
• Will provider access, care coordination, prior authorization or visit limits change?

The practical takeaway

ACOG has called the coding change important for public health. For plan sponsors, it is also a practical planning issue. The shift could make maternity care easier to track and support, but it may also change how costs appear, how claims are managed and how participants experience billing during pregnancy. Plan sponsors that start asking questions now will be better positioned for a smoother 2027 transition.

Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.