CPT 2027 Is Rewriting OB-GYN Billing From the Ground Up; Is Your Practice Ready?
January 1, 2027 is a deadline that should be considered now by every OB-GYN practice. The CPT Editorial Panel of the AMA has approved the biggest change in maternity care coding for years, and the practices that do not get ready until then will definitely suffer financially right away.
(OB/GYN) Medical Billing Services that specialize in obstetrics have been following all of these developments ever since the proposals came out. This is not the case for any ordinary billing departments that handle the OB-GYN as well as other dozens of specialties. It will become evident in the income from the very first claim.
What Actually is Changing in CPT 2027 for OB-GYN?
In a complete elimination of the global obstetric package, which has been used as a method of charging for the services provided to pregnant women during prenatal visits, delivery and postpartum visits for over 30 years, 16 global codes are removed, 6 global codes are amended and 12 new codes have been added. Effective January 1, 2027.
Routine obstetric care (including vaginal delivery), coded as 59400, and routine obstetric care (including caesarean delivery), coded as 59510, will not be available as billing codes anymore. Antenatal visits, labor management, delivery, and postpartum visits should be charged separately based on E/M codes and new specific codes.
According to the American College of Obstetricians and Gynecologists: "The global obstetric codes do not reflect the standard of care delivered today."
Why Does This Change Create a Billing Risk for Unprepared Practices?
There are serious denial-management risks involved when using unbundled billing to bill services today using yesterday's billing rules on the new code set. In the global package, there was only one claim per episode. The new package involves separate claims for each antepartum visit, which involves the proper E/M level, proper medical decision-making documentation for the level, and modifier use when two procedures are performed in a single encounter.
This denial management problem is very real. An OB practice trying to code a prenatal visit as 99204 but lacks documentation of moderate-complexity decision making is bound to either have the code downcoded or denied. Diagnostic imaging, such as obstetric ultrasound (76801-76828) and fetal magnetic resonance imaging, should always be reported as a separate procedure from the antepartum E/M. There is no way to bill these in the same line in the new code set. And OB practices used to billing with global packages will have a lot of work to do when the transition date comes.
What Should OB-GYN Practices Do Before January 2027?
Your preparation should not start in December. Here's all that you can do right now:
- Audit the existing coding processes against the new framework. Make a list of all instances in which the existing process assumes a global package and does not exist for unbundled billing.
- Re-train billing and coding staff on E/M level selection based on prenatal visits only; medical decision-making complexity, time-based reporting, and the documentation for each visit as stand-alone.
- Revise EHR documentation templates to include documentation that would support individual claims for each prenatal, delivery, and postpartum visit.
- Evaluate your contracts with the payers on how they will reimburse you based on the new unbundled reimbursement model.
- Simulate your billing process by doing a simulation of your 2026 encounters billed as 2027 codes to discover any documentation issues or coder confusion.
How Will the CPT 2027 Changes Affect Maternity Claims?
Maternity claims filed using the new payment method will not only be more numerous but also more complicated. Where a practice filed just one claim for a delivery before, now it will have to file several claims during the ante-natal period, the delivery process itself and postnatal period. And all of these will require perfect documentation if they want to be accepted by payers.
The opportunity to earn extra revenue is genuinely good. By unbundling maternity claims, practices can now charge payers for the complexity of treatment in the case when the global payment method did not compensate for the full cost of treating complicated cases. But to take advantage of this opportunity, a practice must have proper infrastructure to deal with claims filing.
Eminence RCM is already preparing OB-GYN practices for the CPT 2027 transition. Get in touch and let us make sure your billing is ready before January 1, 2027!
Frequently Asked Questions
The abolition of global obstetric package codes. Codes such as 59400 and 59510, combining antenatal care, delivery, and postpartum care within one bill, will be removed. As of January 1, 2027, billing will be done in an encounter-based way, where each visit (antepartum, labour management, delivery, and postpartum) will be billed independently with its own unique documentation.
The AMA CPT Editorial Panel has authorized the deletion of 16 global obstetric codes including 59400, 59510, and other global obstetric package codes in use for over 30 years. Six codes are revised, while 12 brand-new service-specific codes will be used to substitute bundled coding.
The effect is two-way. Procedures that deal with difficult patient populations, such as risk pregnancies, comorbidity, and prolonged antepartum monitoring, may see increased revenue due to the fact that unbundling will allow practices to bill for care that was previously underpaid under the global model. Practices with simple patient panels may see flat or decreased revenues if their documentation does not justify the E/M levels being billed for each visit.
The CPT 2027 reorganization will be mainly focused on maternity care coding, which includes antepartum, delivery, and postpartum procedures. Gynecologic procedures, preventive care codes, and non-maternity E/M visits are not affected directly by this reorganization. But OB-GYN practices who serve a significant number of pregnant women will definitely see a drastic change in their revenue cycle.
According to CPT 2027, coding of each antepartum encounter involves the use of an E/M code depending on the environment, complexity of the medical decision making process, or time involved. Justification for the level of coding is expected, and hence, an encounter coded as 99204 should have documentation showing moderate level of complexity of medical decision making rather than merely indicating that there was an encounter.
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