The American Medical Association (AMA) and American College of Obstetricians and Gynecologists (ACOG) have adopted a new coding and billing model for maternity services, effective Jan. 1, 2027.
In preparation of this industry-wide change, Highmark is conducting a comprehensive review of our policies, procedures, and systems to ensure a smooth transition.
We will formally notify you of any changes that may affect your claim submissions for Highmark members.
Why Is This Changing?
Currently, maternity care is billed under one global code that encompasses multiple appointments and services. The AMA has partnered with industry leaders to replace it with service-level coding that better reflects the complexities of modern maternity practice across the four phases of care: antepartum, labor management, delivery, and postpartum. Changes include:
- Current antepartum care codes will be removed, with prenatal visits reported using existing evaluation and management (E/M) codes.
- Current postpartum care codes will also be removed and reported using E/M codes.
- New labor management codes will allow reporting by calendar day and distinguish between straightforward and complex care.
- Delivery codes will be streamlined and reported separately from labor management services.
- New codes will be added for certain obstetric procedures, including third- and fourth-degree laceration repairs, hysterectomy following cesarean delivery, and uterine tamponade.
Visit the AMA’s website for more information regarding these changes: CPT® 2027 Maternity Care Services code changes | American Medical Association.
Next Steps
We will provide updates in Provider News and on the Provider Resource Center regarding any operational or administrative updates prior to Jan. 1.
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