January 1, 2027 marks the beginning of a fundamentally different way of billing maternity care. For months, practices have been hearing about the end of traditional global OB billing. Now the question becomes much more practical: what does your office actually do differently beginning January 1?
The most important change is that routine prenatal care can no longer be thought of simply as a series of visits that will eventually disappear into a global maternity claim. Each 2027 prenatal encounter becomes an individual billable service.1
That affects the front desk, the clinician, coding, billing, and the patient.
Were all of yesterday’s prenatal visits documented, coded, and sent to billing? In 2027 that one question, asked every day, may become the most useful revenue-cycle habit an OB/GYN practice has.
What Changes in the Office on January 1
1. Treat Every Prenatal Visit as an Individual Billable Encounter
Beginning January 1, routine antepartum visits are reported individually using the appropriate E/M coding.1 Each visit now has to make its way from the examination room through documentation, coding, charge entry, and claim submission. A missed encounter can mean missed revenue. That makes one question worth asking every day:
Were all of yesterday’s prenatal visits documented, coded, and sent to billing?
A simple daily reconciliation may become one of the most useful revenue-cycle habits an OB/GYN practice can establish for 2027.
2. Make Sure the Documentation Supports the Service
Under traditional global billing, an individual routine prenatal visit did not ordinarily have to stand alone as a separate claim.
Now it does.
Physicians and other qualified professionals need to document each encounter sufficiently to support the E/M service being reported. The AMA advises that documentation for prenatal visits should include medical decision making and/or time so that it meets E/M requirements.2 Practices should make certain clinicians understand the new documentation expectations before old habits begin producing coding problems or denials.
3. Prepare Your Front Office
This is not simply a change for physicians and coders. Your front-office staff will be dealing with the financial consequences of the new system every day.
- Before the visit, verify the patient’s maternity benefits.
- At check-in or check-out, collect the appropriate copay, coinsurance, or other patient responsibility according to the patient’s benefit plan.
- If the practice gave a pregnant patient a financial estimate during 2026, revisit that estimate for services occurring in 2027. The way those services are billed, and therefore the way the insurer applies the patient’s benefits, may be different.
4. Explain the Change to Patients
Patients need to know what is happening before unfamiliar bills begin arriving.
Under the old global model, patients could experience a substantial portion of their financial responsibility in connection with the larger maternity or delivery claim.
Beginning in 2027, routine prenatal office visits will be billed individually. Depending upon the patient’s insurance benefits, an individual visit may generate a copay, coinsurance, or an amount applied toward the deductible.
In practical terms, the patient’s financial responsibility may accumulate incrementally over the course of prenatal care rather than appearing primarily as one larger maternity charge.
That does not mean every patient will pay the same amount, or that deductibles disappear. Benefit designs vary considerably. It does mean the practice should explain that the pattern and timing of maternity bills may look different in 2027.
Consider putting a short, professionally written notice at the front desk, including it in the patient portal, or giving it directly to patients whose pregnancies cross from 2026 into 2027. A simple message might be:
“Beginning January 1, 2027, national maternity billing rules are changing. Your prenatal office visits may now be billed individually to your insurance plan. As a result, you may see copays, coinsurance, deductible amounts, or insurance statements associated with individual prenatal visits.”
That conversation is much easier to have before the first bill arrives.
5. Watch Payer Behavior Closely
Do not assume every payer will process the new maternity claims identically from day one.3
Watch for payer-specific edits, denials, and requests for additional information. Identify patterns early.
If the same payer begins denying the same type of service repeatedly, the practice needs to know in January, not discover the problem several months later in aging accounts receivable.
6. Keep Watching Your Crossover Pregnancies
Patients who began prenatal care in 2026 remain part of the transition after January 1.
Continue using the external tracking list discussed in our previous article. It provides a straightforward way to distinguish prenatal services performed during 2026 from those performed under the new 2027 structure and helps ensure that no encounter gets lost between the two systems.
Every Encounter Matters
The 2027 maternity coding changes were designed to recognize the work physicians actually perform more accurately.1 But the financial benefit depends upon capturing that work.
Beginning January 1, every prenatal encounter needs to be documented, captured, coded, and billed correctly. And every patient needs to understand that her maternity billing may look different.
This article is part of our series on the 2027 maternity coding changes. Start with Global OB Billing Changes 2027: What OB/GYN Practices Need to Know, then Global OB Billing Ends January 1: What Should Your Practice Do Now?
The first months of a change this substantial will require close attention. The Valletta Group can help practices monitor coding, charge capture, patient billing, and payer response as the new system takes effect, so physicians and their staffs can remain focused on patient care.
Sources
- American Medical Association. CPT® 2027 Maternity Care Services code changes. Updated September 17, 2026.
- American Medical Association. FAQs: CPT® 2027 coding for maternity care spanning transition date. Updated September 17, 2026.
- American Medical Association. FAQs: Preparing for the CPT® 2027 Maternity Care Services code changes. Updated September 17, 2026.
This article is general information about CPT coding changes and is not legal, coding, or payer-specific advice. Confirm transition requirements with each payer.
