FAQs CPT 2027 Coding For Maternity Care Spanning The Transition Date For Antepartum Billing

When maternity care is rendered over the calendar year from 2026 to 2027, it will be reported as per the new coding rules under CPT 2027. Antepartum, labor management, delivery and postpartum services will be reported under a new CPT structure starting January 1, 2027. 

The challenge is not just to learn the new codes; it is also important to identify which rules are applicable to services rendered prior to and subsequent to the transition date. This is particularly important for pregnancies that start in 2026 and are carried over into 2027. 

Understanding how the AMA addresses these transition scenarios can help OBGYN practices apply the appropriate CPT and ICD-10-CM reporting rules. 

How Will the 2026–2027 Transition Affect Antepartum Billing?

Starting January 1, 2027, the global maternity codes are deleted, and antepartum care will be reported per encounter with E/M codes under current E/M rules. For pregnancies that begin in 2026 and deliver in 2027, AMA guidance is clear that each prenatal visit is coded under the rules of the year it was performed, so CPT codes are reported in both calendar years.

How Are 2026 Antepartum Visits Reported?

For visits in 2026, the number of routine encounters that year decides the code:

• One to three visits: Report each with an individual E/M code.
• Four to six visits: Report CPT 59425.
• Seven or more visits: Report CPT 59426.

How Are 2027 Antepartum Visits Reported?

Every encounter on or after January 1, 2027, is reported with the most appropriate E/M code. The level can be selected using either medical decision making or total time.

What Does This Look Like for a Real Patient?

A patient with five prenatal visits in 2026 who delivers in 2027 would be billed 59425 for 2026, followed by individual E/M codes for her 2027 visits.

What Mistakes Should Practices Avoid?

Practices should not switch to E/M early, since all-E/M antepartum reporting does not begin until January 1, 2027. They also do not need to hold 2026 charges until delivery, as these can be coded at the end of 2026 or early 2027. Because payer policies may differ, confirming transition rules with each payer is still recommended.

How should antepartum care be reported when services occur in both 2026 and 2027?

The antepartum services rendered in 2026 should be reported using the 2026 CPT guidelines, while services rendered on or after January 1, 2027, should follow the new 2027 antepartum reporting structure.

Reporting Antepartum Services

For services provided during calendar year 2027:

• 1–3 antepartum visits: Report each visit with the appropriate E/M code.
• 4–6 antepartum visits: Report 59425, Antepartum care only; 4–6 visits.
• 7 or more antepartum visits: Report 59426, Antepartum care only; 7 or more visits.

Reporting Antepartum Services in 2027

For services provided during calendar year 2027, each antepartum encounter will be reported using the E/M code that best represents the service provided.

Example of a 2026–2027 Transition

For example, if a patient has five routine antepartum visits in 2026 and continues receiving prenatal care in 2027 before delivery, the five 2026 visits would be reported with 59425, while the 2027 antepartum encounters would be reported individually using the appropriate E/M codes.

Check Payer-Specific Transition Requirements

Practices should also review payer-specific instructions because third-party payers may establish additional requirements for the transition.

Does the new E/M approach apply immediately to patients who are already pregnant?

No. The patient’s due date does not determine when the new CPT reporting rules begin. The revised maternity care guidelines take effect January 1, 2027.

Antepartum services furnished during 2026 continue to follow the 2026 CPT reporting rules, including the existing use of 59425 and 59426 when the applicable visit thresholds are reached.

For 2026:

• 3 or fewer antepartum encounters during the calendar year = individual E/M codes.
• If 4-6 antepartum visits are provided use 59425.
• Use 59426 when there are 7 or more antepartum visits. 

Beginning January 1, 2027, antepartum services transition to encounter-level E/M reporting under the new maternity care guidelines.

How to Report Routine Antepartum Visits in 2026

For routine antepartum care provided during 2026, the reporting method depends on the number of encounters completed during the calendar year:

• 1–2 routine encounters: Report the applicable E/M code for each encounter and submit the claim after the final encounter.
• 3 routine encounters: Report the applicable E/M codes after the third encounter.
• 4–6 routine encounters: Report CPT 59425, Antepartum care only; 4–6 visits, after the final encounter in that range.
• 7 or more routine encounters: Report CPT 59426, Antepartum care only; 7 or more visits, according to the applicable 2026 reporting guidance.

The AMA specifically notes that the transition to reporting all antepartum encounters individually with E/M codes does not begin until January 1, 2027. Therefore, practices should not switch to individual E/M reporting for all prenatal visits simply because a patient’s delivery is scheduled for 2027.

When Should 2026 Antepartum Claims Be Submitted?

For practices treating patients whose deliveries will occur in 2027, claim timing should take into account the number of routine antepartum encounters ultimately completed during 2026. The AMA recommends submitting E/M-based antepartum claims when there is sufficient certainty about the volume of completed routine encounters. This can help reduce the possibility of amended claims if the encounter count changes late in the year.

When Is 59425 or 59426 Considered Complete? 

For 59425 and 59426, the AMA states that the service is considered concluded when the number of visits represented by the code has been provided. The reported date of service should therefore correspond to the last antepartum encounter included in the reported service. Payer-specific date-of-service or documentation requirements may differ and should be verified before submission.

What About Non-Routine Antepartum Encounters?

Routine encounter counts should not be used to determine reporting for every service provided during pregnancy. The AMA clarifies that non-routine antepartum encounters are not included in the routine visit counts described above. Separately reportable services should be coded according to the circumstances and documentation of the individual encounter.

Does E/M Documentation Matter for 2026 Visits?

Yes. For patients who may require E/M reporting under the 2026 rules, documentation should support the applicable E/M requirements. The AMA specifically advises that prenatal documentation for patients with due dates on or after January 1, 2027, should include medical decision-making and/or time sufficient to support appropriate E/M code selection when E/M reporting is required.

Important: The 2027 CPT maternity-care restructuring becomes effective January 1, 2027. Until then, practices should continue applying the applicable 2026 antepartum reporting rules and should also verify any payer-specific transition requirements.

When should 2026 antepartum services be billed for a patient delivering in 2027?

Practices do not have to wait until the patient’s 2027 delivery to report eligible 2026 antepartum services. The applicable 2026 antepartum services can be reported at the end of 2026 or early in 2027, according to the applicable reporting requirements.

For a patient who will deliver in 2027, the final 2026 routine antepartum visit count determines the appropriate reporting method:

• 1–3 visits: Report each visit with the appropriate E/M code.
• 4–6 visits: Report 59425.
• 7 or more visits: Report 59426.

This approach allows the 2026 portion of the patient’s antepartum care to be reported under the coding rules applicable to that calendar year rather than holding the services until delivery.

How should ICD-10-CM diagnosis coding work for routine antepartum visits in 2027?

The shift to E/M-based maternity care reporting does not change the underlying ICD-10-CM diagnosis rules. For routine antepartum encounters, apply the diagnosis coding guidelines based on whether the pregnancy is normal or involves a documented complication.

• Z34 – Encounter for supervision of normal pregnancy: Use as the first-listed diagnosis for routine outpatient prenatal visits when no pregnancy complication is documented.
• O00 – O9A – Chapter 15, Pregnancy, Childbirth and the Puerperium: Use the appropriate obstetric code when a pregnancy-related condition or complication is documented.
• Z34 + O00 – O9A: Do not report a Z34 code together with a Chapter 15 obstetric code for the same routine prenatal encounter.
• Z3A – Weeks of gestation: May be reported as an additional code to identify the documented week of pregnancy when applicable.
• 2027 E/M transition: The change from global maternity billing to encounter-based E/M reporting does not change these ICD-10-CM diagnosis-selection principles.

What Should OBGYN Practices Do Before the 2027 Transition?

The 2027 maternity coding changes require OBGYN practices to prepare for a calendar-year transition, rather than changing reporting based solely on a patient’s anticipated delivery date. Antepartum services performed in 2026 remain subject to the applicable 2026 CPT reporting rules, while encounters performed on or after January 1, 2027, will follow the new service-level E/M structure.

Review EHR and Practice Management Workflows

Practices should review how their EHR and practice-management systems capture dates of service, encounter types, CPT codes, documentation, and charge information. The system should be able to distinguish 2026 antepartum activity from 2027 encounters so that the correct reporting logic is applied automatically or flagged for coder review.

This is particularly important for pregnancies that span both calendar years. For example, a patient with five routine antepartum visits in 2026 may have those visits reported with 59425, while antepartum encounters performed in 2027 are reported individually with the appropriate E/M codes.

Update Charge Capture and Coding Rules

Billing teams should identify every workflow that currently relies on the existing global maternity or antepartum codes and determine how those workflows will change in 2027. The AMA has confirmed that 17 maternity CPT codes will be deleted, 12 new codes added, and six codes revised, with the new structure becoming effective January 1, 2027.

Practices should therefore update:

• EHR charge capture rules
• CPT code libraries and fee schedules
• Coding and billing workflows
• Claim-scrubbing and validation edits
• Encounter-level documentation prompts
• Reports that track antepartum visits
• Interfaces between EHR, practice-management, and clearinghouse systems

Prepare for Calendar-Year Tracking

For pregnancies crossing December 31, billing teams should track routine antepartum encounters separately by calendar year. This is essential because the number of routine encounters completed during 2026 determines whether 2026 services are reported individually with E/M codes or through 59425/59426. Starting in 2027, all antepartum encounters will move to individual E/M reporting.

A simple year-end review can help identify patients whose antepartum care is likely to span the transition date and prevent 2026 services from being incorrectly carried into a 2027 billing workflow.

Strengthen Documentation for E/M Reporting

Documentation should also be reviewed before the transition. AMA guidance states that prenatal visits for patients with due dates on or after January 1, 2027, should include medical decision making and/or time sufficient to support appropriate E/M code selection when required.

This means providers and coding teams should understand what documentation is needed to support the selected E/M service rather than relying on the previous bundled-care workflow.

Review Payer and Contract Requirements

CPT guidance establishes the coding framework, but practices should not assume that every payer will implement the transition identically. The AMA advises practices to check with third-party payers for additional policies concerning the 2026–2027 transition.

Payer review should include:

• Effective dates for new and deleted codes
• Claim submission requirements
• Payer-specific coding edits
• Timely-filing rules
• Fee schedule changes
• Medicaid or state-specific requirements
• Any special instructions for pregnancies spanning 2026 and 2027

For example, Aetna has already announced upcoming maternity coding changes effective January 1, 2027, along with new claim edits beginning December 1, 2026, demonstrating why practices should review payer communications before the transition date.

Train Providers, Coders, and Billing Teams

Finally, implementation should not be limited to updating code tables. Providers, coders, charge-entry staff, billers, and revenue cycle teams should understand when the 2026 rules end, when the 2027 rules begin, and how to handle patients whose care spans both periods.

A short transition checklist, targeted staff training, and pre-2027 claim audits can help identify workflow gaps before the new reporting structure takes effect. AMA guidance also highlights education, proactive auditing, and compliance programs as useful preparation measures for appropriate use of the new codes.

How Should Labor Management Be Reported When It Spans December 2026 and January 2027?

Reporting will be based on whether the physician’s or other QHP’s labor-management service is a continuous visit between the two calendar dates (December 31, 2026 and January 1, 2027). 

According to the CPT 2027 maternity care guidelines: 

• Continuous labor management: If the provider maintains continuous personal attendance focused on the same patient across midnight, the service is treated as one continuous service.
• 2027 labor management code: When the service meets the continuous-visit criteria, the initial labor management service may be reported on January 1, 2027 using:
  • 59080 – Initial day, straightforward labor management
  • 59081 – Initial day, complex labor management
• Non-continuous care: If the labor management service is not suitable for continuity between the two dates, the service in December 31, 2026 could possibly be reported with an appropriate initial hospital inpatient/service provided in an observation E/M code, 99221-99223. 
• E/M reporting: Codes 99221–99223 may be selected based on either medical decision making or total time on the date of service, when applicable.
• Payer review: Because this represents a transition-period scenario, practices should verify payer-specific requirements before submitting the claim, particularly when the labor management does not qualify as a continuous service.

The important consideration is whether the provider’s labor-management service is uninterrupted over the calendar-date change. It is not necessary to use the reporting method that is appropriate because of the date of delivery.

How Should a 2026 Delivery Be Coded When Postpartum Care Occurs in 2027?

When delivery occurs in November or December 2026, the delivery remains subject to the 2026 CPT maternity care reporting rules, even if some postpartum services take place after January 1, 2027.

• Delivery in 2026: Report the appropriate global maternity care code, using the 2026 coding requirements, as needed, such as 59400. 
• Postpartum care in 2027: Postpartum services performed on or after January 1, 2027, may be reported separately using the appropriate E/M code under the new 2027 reporting structure.
• 2027 transition: The fact that postpartum care extends into 2027 does not change the CPT reporting applicable to a delivery that occurred in 2026.

Therefore, practices should distinguish the delivery date from the date of subsequent postpartum encounters when determining which maternity care reporting rules apply.

Stay Ready for the 2027 Maternity Coding Transition With CureCloudMD

The shift from global maternity billing to encounter-based reporting makes accurate coding, documentation, and claim workflows more important for OB/GYN practices. CureCloudMD helps practices manage these changes through specialized OBGYN Medical Billing Services, supporting accurate charge capture, CPT and ICD-10-CM coding, claim submission, and payer-specific requirements across the maternity revenue cycle.

With the right billing workflow in place, practices can navigate the 2026–2027 transition with fewer reporting errors while keeping claims moving efficiently through the revenue cycle.