Maternity care coding is set to break apart a long-standing OB/GYN bundle
Starting Jan. 1, maternity care will no longer be reported as a single global package under the Current Procedural Terminology code set maintained by the American Medical Association. Prenatal care, labor management, delivery and postpartum care will be separated into distinct billable services, with each prenatal and postpartum visit reported as its own evaluation and management encounter. The code revision is substantial: 17 codes are deleted, 12 are added and six are revised.
For many obstetric practices, the billing change is not just administrative. It reaches into physician compensation, payer contracting, compliance review and how work is attributed across physicians, advanced practice providers and midwives. Employed OB/GYNs paid on productivity measures may feel the first impact because the work RVU stream that once flowed through a single delivery bundle will now be split across multiple encounters and multiple clinicians.
A single vaginal delivery can now look very different on paper, even when the bedside work remains familiar.
Productivity math changes when prenatal and postpartum care are no longer hidden inside the delivery code
Under the current global structure, a physician can accumulate work RVUs from prenatal visits, the delivery itself and postpartum care under one episode of care. Under the new structure, those visits are no longer locked inside a single delivery code. If a mid-level provider handles prenatal or postpartum visits, those services will be billed by that clinician rather than attributed to the physician under the global package. That shift changes both reimbursement flow and the denominator employers use to assess productivity.
The new structure also introduces levels of complexity for services that did not previously have that kind of granular billing distinction inside the global maternity package. Practices will need to understand exactly what documentation supports each level, because complexity coding can cut in both directions. If clinicians code too high without records to support it, compliance risk rises. If they undercode, the practice leaves legitimate reimbursement behind. In a service line where margins are often tight and workflows are tightly coordinated, small documentation differences can echo through compensation models.
Hospital-employed OB/GYNs are likely to feel the change first
Private practices tend to rely more heavily on collections or revenue attribution, so the coding shift may be absorbed differently there. The sharper pressure point is the employment setting, where hospitals often tie a portion of OB/GYN compensation to work RVUs. Once prenatal and postpartum visits are billed separately by the individual provider who performs them, the pool of attributed RVUs can change quickly, especially in groups where advanced practice providers or midwives complete a meaningful share of visit volume.
Employers are already asking how to avoid disruption while staying compliant. That tension runs through every piece of the transition. If the billing structure changes but compensation formulas do not, physicians may see a mismatch between the effort they contribute and the RVUs or pay they receive. If employers adjust too aggressively without enough data, they risk overcorrecting and creating a different problem later in 2027.
Laborists and OB hospitalists may gain new billable work, but not necessarily new margin
Laborists and OB hospitalists are among the groups most directly affected by the addition of labor management codes. In the old global model, these physicians typically billed the delivery itself. Under the new coding structure, time spent managing a patient in labor for 24 or 48 hours before delivery can potentially be captured separately.
At first glance, that seems like it could offset hospital subsidies for laborist programs, many of which depend on institutional support because delivery services are often undercompensated relative to physician effort. The modeling discussed here did not show a material reduction in subsidies, though, because the delivery code itself carries fewer work RVUs in the new structure. The added labor management billing does not necessarily translate into a windfall if the core delivery value is simultaneously reduced.
Budget neutrality will not feel neutral to every physician
CMS and the AMA have framed the redesign as budget neutral overall, but that does not guarantee budget neutrality for individual clinicians. The assumptions matter. For uncomplicated vaginal delivery, the package calculations assume eight prenatal visits and two postpartum visits. A physician who sees more or fewer than that will land in a different spot once the math is run on actual clinical volume. The complexity levels attached to office visits can also shift the final result.
PYA’s modeling of an uncomplicated vaginal delivery found 4.03 fewer work RVUs under the new code set than the 37 credited to the current global code. That is a real drop, even before any practice-specific variation is layered on top. For a clinician who performs many deliveries, a small change per case can turn into a meaningful shift in annual productivity.
Mixed payer adoption could complicate RVU tracking across a full panel
CMS has proposed adopting the new codes in its 2027 Medicare Physician Fee Schedule, while also soliciting comment on 15 G-codes that would preserve the bundled structure for Medicare. Comments closed Sept. 14, and the final rule has not been released. Commercial payers often follow Medicare’s lead, but not always at the same pace, and Medicaid policies may diverge by state.
That creates an operational problem for employer groups. One payer may adopt the unbundled structure while another still pays the global package. In that setting, productivity tracking may need to capture personally performed services payer by payer, then allocate RVUs across the physician who rendered care. The administrative burden rises fast when the same clinical episode is paid under two different structures at the same time.
Compensation formulas may need temporary guardrails rather than a permanent rewrite
Health systems are responding in different ways. Some are preparing to freeze compensation at 2026 levels, let 2027 run its course and then revise formulas based on actual productivity. Others believe the change will not be material enough to require immediate intervention. A common approach is to preserve physician income at least through the first year while the organization learns how the new billing rules behave in real practice.
For fair market value and compliance teams, the safest approach may be a temporary one. If an employer chooses to adjust conversion rates before the new codes are fully understood, reconciliation checkpoints at six and nine months can help identify whether the revised formula is overpaying or underpaying clinicians. Without those checkpoints, a health system can move through an entire year before realizing the new formula drifted away from actual work performed.
Survey data will also lag the policy change. The 2027 benchmark data will reflect 2026 payment behavior, while 2028 data will reflect 2027. During that interval, employers and advisers will have to decide how much confidence to place in the numbers, especially if some organizations freeze compensation while others move immediately to the new structure. Similar distortions followed COVID-19 and the 2021 CMS shift that increased the weight of office-based evaluation and management services. The adjustment period is familiar, but it is not short.
Employment contracts should anticipate the first year’s volatility
Employed OB/GYNs who expect their compensation to be affected should ask employers whether 2026 levels will be frozen for a transition period and whether any productivity formula will be reconciled after the first six to nine months. Contract language should also address how personally performed services are counted if different payers adopt the new codes at different times. Without that clarity, physicians may face an income swing that reflects coding mechanics more than actual clinical effort.
The immediate risk is not abstract. A physician can work the same schedule, deliver the same patients and still see a different RVU total once visits are split apart, labor management is separately billed and mid-level provider work is removed from the physician’s global bundle. In 2027, the dispute will not be whether maternity care is being delivered; it will be how that care is counted, who gets credit for it and whether the compensation model keeps pace with the clinical work.