Global Obstetric Billing Ends in 2027. Obstetric Reimbursement Changes With It.
For decades, obstetric practices have built their workflows, staffing models, schedules and revenue projections around the assumption that maternity care would ultimately be reimbursed through a global payment after delivery.
That assumption expires on January 1, 2027.
When the AMA deletes the current global obstetric package codes, including familiar codes such as 59400 and 59510, maternity care will move to a fundamentally different reimbursement structure that values individual encounters, documentation and care management activities rather than a bundled episode of care.
The coding changes themselves are important, but what healthcare leaders should really be paying attention to is what those changes signal about the future of obstetric care.
The Current Procedural Terminology (CPT) update is significant, but it’s also recognition that modern pregnancy care is no longer delivered by a single physician in a single office following a predictable pathway.
For Physicians, Documentation Is About To Matter More Than Delivery Volume
Many physicians have spent their careers practicing under a system where the complexity of an individual prenatal visit had little impact on reimbursement.
Under the new framework, antepartum visits will be reported using traditional E/M coding, and reimbursement will increasingly depend on documentation of medical decision making, risk assessment and time spent managing the patient’s care.
Consider the difference between:
- A routine low-risk prenatal visit
- A patient with chronic hypertension
- A patient with gestational diabetes requiring medication adjustments
- A pregnancy complicated by significant behavioral health concerns
Clinically, physicians already know these visits are not equivalent. Beginning in 2027, the coding structure is finally catching up to that reality. The question many organizations should be asking today is not whether providers understand obstetrics, but whether they understand E/M documentation well enough to capture the work they’re already performing.
I traveled the Southeast in 2021 to educate providers regarding the 2021 E&M guideline changes. Implementing those changes often required significant EHR template updates, and many practices chose not to make them. As I conduct chart reviews, I often see documentation lacking in specific problems addressed and their severity. In almost all situations, the risk of complications is not detailed to support the level of service.
We are seeing auto-downcoding of the service by insurance carriers who scrutinize claims by the severity of the diagnosis. If the service level is high but the diagnosis does not support the level billed, the company will downcode to force the provider and billing team to provide documentation to support the higher level.
For Administrators, Revenue Integrity May Replace Global Billing Efficiency
Global obstetric billing offered simplicity.
One patient.
One package.
One reimbursement methodology.
The new model introduces substantially more granularity. Every visit, every labor management encounter and every postpartum service becomes a potential revenue event requiring accurate documentation, coding, claim submission and payer adjudication.
That creates both opportunity and risk.
Organizations that invest in provider education, auditing and workflow redesign could find themselves appropriately reimbursed for complex maternity care that historically went uncompensated.
Organizations that underestimate the operational impact may experience increased denials, coding variation and revenue leakage during the transition period.
In other words, 2027 may create a wider performance gap between practices with strong revenue cycle processes and those that relied upon the simplicity of global billing.
The Biggest Winners May Be Practices Providing High-Complexity Care
One of the most overlooked aspects of the transition is that the current global model often fails to distinguish between uncomplicated and highly complex pregnancies.
A practice caring for large numbers of patients with diabetes, hypertension, obesity, mental health conditions or maternal-fetal medicine involvement frequently performs substantially more work than a practice managing predominantly low-risk pregnancies.
Historically, much of that effort was absorbed into the same global payment.
The new coding framework creates opportunities to report many services individually, including screening activities, patient education and medically necessary evaluation and management services that previously disappeared into the global package.
What Smart Organizations Are Doing Right Now
The most successful organizations are already asking strategic questions before the final 2027 CPT manual:
- Do our physicians consistently document E/M services at the level supported by their medical decision-making?
- Can our EHR support the new workflow requirements?
- Are our coders prepared for a significantly larger volume of encounter-based coding?
- Have we started discussions with commercial payers regarding implementation plans?
- Do providers understand ACOG’s recommendation to begin using E/M services with modifier TH for patients likely to deliver in 2027?
The organizations that start preparing now will likely experience the transition as an operational adjustment. The organizations that wait until late 2026 may find themselves rebuilding clinical, coding and revenue cycle workflows simultaneously.
The Bigger Story
The coding changes are significant, but the shift away from a reimbursement model built around a single global payment may have a greater effect on practice operations.
Multidisciplinary care teams, risk-based management, laborists, maternal-fetal medicine specialists, behavioral health integration and individualized prenatal care have become standard parts of modern obstetrics. The payment system is finally starting to acknowledge reality.
And for organizations willing to prepare early, the end of global OB billing may prove to be less of a disruption and more of an opportunity.
What These Changes Will Look Like in Real Life
Many physicians and administrators are focused on how they will bill patients beginning January 1, 2027. Here are a few common scenarios that illustrate the shift.
Scenario #1: The Routine Low-Risk Prenatal Patient
Today (Global Billing)
A patient receives routine prenatal care throughout pregnancy and delivers vaginally without complications. Most of the physician work eventually rolls into a global obstetric package such as CPT® 59400.
Starting in 2027
Instead of waiting for a single global payment:
- Each prenatal visit is reported using the appropriate E/M code.
- Delivery is reported separately using the new delivery-specific codes.
- Postpartum visits are reported separately using E/M services.
- Any separately identifiable screening or counseling services may be reported when supported by documentation and payer policy.
For many low-risk pregnancies, total reimbursement may look similar. The difference is that revenue is now tied to individual encounters instead of the pregnancy episode as a whole.
Scenario #2: The Hypertensive Pregnancy
Today (Global Billing)
A physician sees a patient with chronic hypertension at 30 weeks’ gestation.
During the visit, the provider:
- Reviews home blood pressure logs
- Adjusts medication management
- Reviews laboratory results
- Discusses preeclampsia warning signs
- Coordinates care with maternal-fetal medicine
Under the traditional global model, much of this additional physician work generated no additional reimbursement beyond the global package.
Starting in 2027
Under the new structure, the visit is evaluated on its own merits using E/M guidelines, allowing the complexity of the medical decision-making to be reflected in coding selection when documentation supports it.
For physicians managing large populations of high-risk patients, this may be one of the most financially significant aspects of the transition.
Scenario #3: Gestational Diabetes Requires Intensive Management
Today (Global Billing)
Consider a patient requiring:
- Weekly glucose review
- Nutritional counseling
- Medication titration
- Frequent physician communication
- Additional surveillance
Historically, providers often described these pregnancies as “a lot of work for the same global payment.”
Starting in 2027
The new model acknowledges that not every prenatal visit carries the same clinical burden. E/M-based coding creates the opportunity for reimbursement to better align with the complexity of care being delivered.
This is particularly important for organizations caring for medically complex maternity populations.
Scenario #4: Transfer of Care at 34 Weeks
One of the longstanding frustrations with global obstetric billing has been transfer patients.
Today (Global Billing)
A rural physician may provide prenatal care for seven months before transferring the patient to a tertiary center for delivery.
Under the global model, determining which provider receives payment often led to administrative complications, split-billing arrangements and reimbursement disputes.
Starting in 2027
Under the encounter-based model:
- The referring physician bills for services already provided
- The receiving provider bills for subsequent prenatal care
- The delivering physician bills for delivery services
In many situations, the coding becomes more straightforward because reimbursement follows the actual care rendered.
Scenario #5: Prolonged Labor
Today (Global Billing)
A laboring patient spends two days in active management before delivery.
Historically, labor management efforts were absorbed into the global package regardless of the intensity of physician involvement.
Starting in 2027
The new CPT structure introduces labor management coding by calendar day, allowing physicians to report prolonged intrapartum management separately from the delivery itself.
This represents a meaningful change for laborists, hospital-employed OB physicians, and practices managing high-acuity labor and delivery units.
The Question Every OB Department Should Be Asking
The organizations that benefit most from these changes will not necessarily be those that see the highest patient volumes.
They’ll be the organizations that can accurately answer three questions:
- Are physicians documenting the complexity of the care they already provide?
- Can coders consistently translate that documentation into appropriate E/M and maternity-specific coding?
- Can administrators redesign workflows that were built around a global billing model for more than 30 years?
To learn more about this transition, contact your Warren Averett advisor directly, or ask a member of our team to contact you.
