Maternity care billing shifts from one global package to separate services in 2027
Starting Jan. 1, maternity care moves away from the familiar global package that has long bundled prenatal care, delivery and postpartum care into a single code. Under the 2027 revision to the Current Procedural Terminology code set maintained by the American Medical Association, those services will be reported separately, with antepartum care, labor management, delivery and postpartum care each broken out on its own. Prenatal and postpartum visits will be billed as individual evaluation and management services rather than being folded into a global maternity payment.
The code overhaul is not a cosmetic edit. It deletes 17 codes, adds 12 and revises six, which means the change reaches deep into documentation habits, reimbursement patterns and physician compensation formulas. In practices that have relied on a single bundled payment to track maternity work, the new structure will force a more granular accounting of who provided care, when it was provided and how complex that service really was.
One uncomplicated vaginal delivery modeled by PYA translated into 4.03 fewer work RVUs under the new structure than the 37 work RVUs assigned to the global code.
Compensation models will absorb the first shock in employed OB/GYN groups
Carol Carden, CPA, ABV, ASA, CFE, managing principal of compensation valuation, planning and design at PYA, said employers that pay obstetrician-gynecologists on work RVUs will feel the change most sharply. That is especially true in hospital-employed settings, where physician compensation often includes at least some RVU-driven component. When work that once landed inside a single global code is separated into distinct services, the physician no longer automatically receives credit for all of those encounters under one umbrella.
The practical effect is immediate. If a mid-level provider performs some prenatal visits or postpartum visits, those encounters will now be billed under that provider rather than being attributed to the physician. Under the current global package, those work RVUs typically flow to the physician. Once the services are split apart, the work attached to those visits can move with the provider who actually delivered the care, and compensation formulas tied to physician RVU production may fall as a result.
Private practice groups may feel a different pressure. Their compensation structures often depend more on collections or revenue attribution than on work RVUs, so the shift may not hit them in the same way. Even there, though, the billing change can alter the way income is distributed across physicians, advanced practice providers and midwives, particularly when patient care is shared across a maternity episode.
Documentation will matter more when complexity levels enter the billing equation
The new code structure introduces levels of complexity for these services, and that layer does not exist in the same way under the global package. Practices will have to match the documented record to the complexity level they bill, which places a premium on precise charting and coder education. Billing a higher level than the documentation supports invites compliance exposure. Billing too conservatively leaves reimbursement on the table.
This is where the clinical workflow becomes inseparable from the revenue cycle. Antepartum and postpartum visits are routine in many obstetric practices, but they still must be documented with enough clinical detail to justify the level chosen. The new system rewards specificity. It also punishes sloppiness, because the old habit of relying on the global maternity code no longer covers the full span of services in a single transaction.
Laborists, APPs and midwives may see the most operational rebalancing
Hospitals and large employed groups are asking what the split will mean for laborists, advanced practice providers and midwives, since those clinicians often carry a meaningful share of prenatal and postpartum care. When individual visits are billed separately, each professional’s contribution becomes more visible in the revenue cycle. That visibility can improve accuracy, but it can also expose how much of the traditional OB/GYN global package was previously flowing to the physician by default.
For laborists, the consequences may be especially complex because their role is anchored in delivery services and inpatient obstetric coverage, while outpatient maternity care often involves a broader team. If prenatal and postpartum encounters are no longer wrapped into the physician’s global payment, the compensation structure may need to be redesigned so that physician productivity, mid-level productivity and actual collections remain aligned.
The billing change also raises a familiar issue in health care finance: the gap between service delivery and payment attribution. A physician may oversee the pregnancy, but if another clinician carries out the visit, the financial credit can now follow the hand that performed the work. In a bundled model, that detail was muted. In the new model, it becomes visible.
Medicare is still unresolved, but employers cannot wait for the final rule
CMS proposed adopting the new codes in its July 14 proposed 2027 Medicare Physician Fee Schedule, while also asking for comment on 15 G-codes that would preserve the bundled structure for Medicare. The AMA has urged CMS to finalize the new code set without those G-codes. Comments closed Sept. 14, and the final rule has not yet been released.
Even with Medicare still undecided, Carden advised organizations to plan as though the new structure will take effect. Medicare is not a dominant payer for obstetric services, but commercial payers often follow Medicare’s lead. In payment policy, that kind of downstream adoption can quickly turn a coding change into an across-the-board operational shift. Practices that wait for absolute certainty may end up redesigning compensation plans, billing workflows and compliance checks under much tighter time pressure.
Employers are already working through how to make the transition without disrupting physicians while still protecting themselves from compliance risk. That balancing act will likely shape contract language, internal productivity benchmarks and reimbursement forecasts throughout 2027. In some organizations, the hardest part will be the recalibration of expectations rather than the coding itself.
Carden’s warning lands because the change reaches beyond billing mechanics. OB/GYN compensation, provider attribution and compliance oversight all sit on top of the same coding foundation. Once that foundation changes, every downstream calculation changes with it.