Maternity CPT coding modernization: what Geisinger Health Plan providers need to know

The American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) have finalized long‑anticipated changes to maternity CPT coding that will modernize how maternity services are reported and billed. Geisinger Health Plan (GHP) expects that, once implemented, these changes will apply consistently across all GHP plan offerings.

Importantly, there are no changes to provider contracts with GHP as a result of these coding updates. The changes affect how services are coded and reported, not contractual terms, reimbursement methodologies or participation requirements.

GHP is actively preparing for this transition and will work closely with providers to ensure a smooth, coordinated implementation.

Why maternity coding is changing

The existing maternity coding framework is more than 30 years old and relies heavily on bundled or “global” billing. Industry leaders determined that this structure no longer reflects modern maternity care delivery and limits visibility into how care is provided across pregnancy, labor, delivery, and postpartum.

The updated CPT structure is intended to:

• Improve transparency into maternity services delivered over time
• Increase accountability and accuracy in reporting
• Provide greater visibility into the complexity and intensity of care

To achieve these goals, global maternity billing is being eliminated and replaced with service‑level coding aligned to discrete phases of care.

High‑level overview of CPT changes

Under the new CPT maternity coding framework:

• 17 existing CPT codes will be deleted
• 12 new CPT codes will be added
• 6 CPT codes will be revised
• Global or bundled maternity billing will be eliminated
• Maternity services will be billed at the individual service or phase level

Maternity care organized into four phases

Maternity care will now be reported across four defined phases, each with specific coding expectations.

1. Antepartum care

• Prenatal visits are billed individually using standard Evaluation and Management (E/M) codes
• Documentation follows established E/M medical decision‑making or time‑based rules
• Maternity‑specific modifiers and identifiers are used to flag pregnancy‑related services
• Separate reporting is allowed for ancillary and supportive services that were not captured under global billing

2. Labor management (new phase)

• New per‑day CPT codes report management of labor
• Codes differentiate:
• Initial versus subsequent days
• Straightforward versus complex labor care
• Labor management includes examinations, physiologic monitoring, and induction or augmentation
• Labor management services may be billed independently of delivery services

3. Delivery care

• Delivery‑only codes are used for vaginal and cesarean deliveries
• Billing is not dependent on which provider delivered antepartum or labor care
• Delivery care begins once labor is complete
• Delivery services may be billed alongside labor management
• New codes address more complex delivery‑related services, including laceration repairs

4. Postpartum care

• Postpartum visits are reported using E/M codes
• Postpartum services cannot be billed on the same calendar day as delivery
• New postpartum‑specific procedure codes are introduced
• Ongoing outpatient management and care coordination for postpartum conditions may be billed separately

CPT codes expected to be impacted

Below is a link to the maternity‑related CPT codes expected to be deleted, added, or revised as part of the 2027 CPT update. Deleted codes include long‑standing global obstetric and delivery‑related codes. Revised codes will have updated definitions or guidance to align with the new maternity care framework. And new codes will support service‑level reporting across antepartum, labor management, delivery, and postpartum care.

CPT® 2027 Maternity Care Services code changes | American Medical Association

Transition and implementation approach

GHP is actively working toward implementation of the new maternity CPT coding structure. We’ll notify you in advance of any maternity code changes being put in place for your GHP claims. Until you are formally notified by GHP, continue billing maternity services as you do today.

As this transition progresses:

• GHP will communicate clearly before any billing changes are required
• Providers will receive education, guidance, and operational support
• Grace periods will be built into the transition to minimize administrative disruption
• GHP will collaborate with providers to address questions, workflows, and system readiness

Our goal is to make sure providers have ample time, support and clarity before any required changes take effect.

What to expect next

Additional communications will be shared as implementation planning continues, including operational details, billing guidance, and educational resources. We appreciate your partnership as the industry transitions to a more transparent and modern approach to maternity care coding.

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