2027 Maternity Services Updates from CMS

Healthcare payers are approaching a significant change in maternity claims processing. Beginning January 1, 2027, the American Medical Association's CPT restructuring will eliminate traditional global obstetric codes, including CPT 59400 and 59510, and introduce a more detailed approach to maternity care billing.



CMS has been evaluating how Medicare should accommodate these changes, creating important considerations for health plans, claims administrators, and payment integrity teams.

What's Changing in Maternity Billing?

The 2027 restructuring introduces a more granular approach to maternity services, separating care into four phases:

• Antepartum care, including individual evaluation and management encounters
  
• Labor management
• Delivery services
• Postpartum care

CMS has also considered establishing 15 HCPCS G-codes to preserve a bundled billing option for Medicare claims.

These alternatives could create different billing pathways depending on the applicable payer, program, and finalized reimbursement policies.

Payer Suggestions on Preparing for the Maternity Service Changes

PCG Software's Virtual Examiner® (VE) provides automated claims auditing capabilities that help healthcare payers identify potential coding, billing, and reimbursement discrepancies. As maternity coding requirements evolve, VE can support health plans in adapting their payment integrity programs to the new billing structure.

Identifying Obsolete CPT Codes

Beginning January 1, 2027, traditional global obstetric CPT codes, including 59400 and 59510, are scheduled for deletion. With updated coding rules, Virtual Examiner can identify claims containing obsolete procedure codes based on the applicable date of service, helping prevent incorrect reimbursement.

Detecting Duplicate and Incompatible Billing

The transition toward separately reported maternity services introduces opportunities for overlapping or duplicate billing. VE can identify potentially incompatible combinations of antepartum, labor management, delivery, and postpartum services, including situations where bundled and individually reported procedures conflict with applicable billing requirements.

Validating Coding and Reimbursement Accuracy

Changes to maternity CPT codes and reimbursement methodologies require health plans to update their claims processing and auditing rules. Virtual Examiner can evaluate claims against configured coding guidelines, reimbursement policies, and payer-specific requirements to identify potential discrepancies before or after payment.

Monitoring Provider Billing Patterns

Beyond individual claim reviews, Virtual Examiner can help identify recurring coding inconsistencies and potentially inappropriate billing patterns across providers. These findings can support targeted audits, provider education, and broader payment integrity initiatives.

Provider Suggestions on Preparing for the Maternity Service Changes

The 2027 maternity CPT restructuring introduces new challenges for healthcare providers, particularly those relying on existing billing software to manage coding, documentation, and claim submissions.

PCG Software's Virtual Examiner® (VE) can integrate coding intelligence and configurable auditing rules into compatible billing systems through Virtual Examiner Web Services™ (VEWS). This allows providers to pre-audit claims, identify potential billing errors, and correct discrepancies before submitting claims to health plans.

Identify Obsolete Maternity CPT Codes Before Submission

Beginning January 1, 2027, traditional global obstetric codes, including CPT 59400 and 59510, are scheduled for deletion. Providers must ensure their billing systems recognize the updated coding structure.

Through VEWS integration, Virtual Examiner can evaluate procedure codes against updated code sets and applicable dates of service, flagging obsolete codes before claims are submitted. This helps billing teams identify coding problems that could otherwise result in claim rejections or denials.

Detect Duplicate or Overlapping Maternity Services

The transition from global obstetric billing toward more detailed service reporting creates additional opportunities for duplicate or overlapping charges. Virtual Examiner can apply configured coding rules to identify potentially incompatible combinations of antepartum visits, labor management, delivery procedures, and postpartum services. Billing personnel can review flagged claims and correct inappropriate combinations before submission.

Validate Coding Combinations and Modifiers

Changes to maternity coding may require providers to reassess how procedure codes, modifiers, and related services are reported together. By integrating VE's auditing rules into existing billing workflows, providers can identify potentially incorrect modifier usage, incompatible procedure combinations, and other coding inconsistencies. These automated checks support more consistent coding practices without requiring every claim to undergo a separate manual review.

Identify Potential Reimbursement and Billing Discrepancies

Updated maternity coding structures may also change reimbursement methodologies, billing units, and payer-specific payment policies. Virtual Examiner can evaluate claims against configured coding and reimbursement rules to identify potential discrepancies before submission. This gives billing teams an opportunity to investigate questionable charges and reduce avoidable payment delays.

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