Interim Maternity Care Billing Guidance Effective Immediately
Review the guidance below for prenatal and maternity billing prior to and after January 1, 2027.
What providers need to know
The American Medical Association (AMA) and American College of Obstetricians and Gynecologists (ACOG) have announced significant maternity care billing and coding changes effective January 1, 2027. Current global maternity care codes will be replaced by new and revised codes that separately identify antepartum care, labor management, delivery, and postpartum care.
To support the transition, here is our recommendation on interim billing guidance for prenatal care services furnished during calendar year 2026 for pregnancies with expected delivery dates on or after January 1, 2027.
Interim Billing Requirements
|
Prenatal visits during pregnancy |
Billing guidance |
|
4-6 antepartum visits |
CPT 59425 |
|
7 or more antepartum visits |
CPT 59426 |
|
Fewer than 4 antepartum visits |
Continue to follow current 2026 CPT coding guidance |
Transition Billing Scenarios
|
Scenario |
Billing guidance |
|
Delivery expected before January 1, 2027 |
Bill maternity care in accordance with currentContract Exhibit B Compensation Agreement, AHCCCS and national guidance, including applicable global maternity care codes. |
|
Prenatal care provided during 2026; delivery expected on or after January 1, 2027 |
Bill 2026 prenatal care services using CPT 59425 for 4-6 visits or CPT 59426 for 7 or more visits, as applicable. |
|
Any maternity care service furnished on or after January 1, 2027 |
Bill using 2027 maternity care coding requirements. |
Provider Action Checklist
- Inform appropriate coding, billing, clinical, and revenue cycle staff of the upcoming elimination of global maternity care billing codes effective January 1, 2027.
- Review operational and billing processes affected by unbundled maternity care coding.
- Ensure prenatal services furnished during 2026 are appropriately billed and documented for pregnancies expected to continue into 2027.
- Assess affected claim edits, charge masters, templates, and practice management systems.
- Continue to submit the Maternal Health Risk Assessment to the AZ Blue Health Choice maternal health department; fax to (480) 760-4762. Click here for the Maternal Health Risk Assessment Form.
- Monitor AZ Blue Health Choice and AHCCCS communications for additional coding, claims submission, reimbursement, and implementation guidance.
Additional Resources
- AMA's maternity care coding resources page: CPT® 2027 Maternity Care Services code changes | American Medical Association