Guidance on New Coding and Billing Model for Maternity Care

Highmark is implementing the American Medical Association’s (AMA) new coding and billing model for maternity care. The AMA has stated that this industry-wide change allows for more accurate reporting of team-based care, improved data quality, and better alignment with evidence-based maternity care.

Currently, providers generally submit a single global maternity claim after delivery that covers antepartum care, labor management, delivery, and postpartum care. Under the new AMA coding structure, providers will submit claims for services as they occur throughout the pregnancy journey.

We recognize that this change may prove challenging, and our teams are focused on making this transition as seamless as possible for members and providers.

Deliveries Expected on or after Jan. 1, 2027

For pregnant members with due dates on or after Jan. 1, 2027, providers should begin transitioning to the new billing model on Oct. 1, 2026, by utilizing evaluation and management (E/M) codes with the TH modifier only. The new CPT codes for labor and delivery will not be available until Jan. 1, 2027, at which time the current global maternity codes will be retired.

As a result, a transition period will exist between Oct. 1, 2026, and Dec. 31, 2026. During this period, the appropriate billing approach will depend on the number of antepartum visits completed in 2026.

Per guidance from the American College of Obstetricians and Gynecologists (ACOG):

• 7 or more antepartum visits (CPT 59426)
• 4-6 antepartum visits (CPT 59425)
• Fewer than 4 antepartum visits (E/M codes with TH modifier)

All patients who initiate maternity care on or after Oct. 1 must be billed under the new model and are not eligible for global maternity billing. For pregnant patients with due dates on or before Dec. 31, 2026, continue to use the current billing system.

The AMA states that this industry-wide change is designed to be revenue-neutral for both providers and payers, and Highmark will update its base fee schedule as appropriate.

Reimbursement Policy (RP) Updates

To meet the requirements of the new billing model, Highmark will update and merge reimbursement policies RP-023 Newborn Care, Obstetrical Delivery, Antepartum and Postpartum Care, and Associated Services and RP-056 Delivery Payment Equivalency, effective Oct. 1, 2026.

The newly merged policy will be RP-023 Maternity Care and Delivery Services. RP-056 will be retired and archived.

Stay Informed

We will continue to provide updates in Provider News and on the Provider Resource Center regarding any operational or administrative changes prior to Jan. 1.