A quiet policy change taking effect this year will likely increase what your organization pays for maternity care, and you may not see it coming until the bills arrive. The American Medical Association (AMA) will eliminate global maternity professional codes at the end of this year. Under the new payment system, obstetricians and midwives will be paid fee-for-service for the care they deliver before, during and after deliveries. This is a shift that has direct implications for your benefits budget and planning.
Obstetricians and midwives have been paid a global fee for their services during delivery since the 1990s. This has made it easier to predict maternity costs, but providers must wait until after delivery to be paid for their services. The existing codes don’t allow differential payments for women at higher risk. Women giving birth in the U.S. are at higher risk than a decade ago, with more older women getting pregnant and an increased prevalence of obesity.
How the new coding structure works
The two global professional codes for vaginal and cesarean section deliveries will be replaced with 12 new and six revised fee-for-service codes for prenatal and postnatal visits, fetal monitoring during delivery and various procedures. Obstetricians and midwives will bill for level two through five office visits for prenatal and postpartum visits. The amount of allowable charges could vary from visit to visit. Any increase in the cost of prenatal and postpartum visits is paid for by the plan without any member cost sharing under the Affordable Care Act.
Providers will bill fee-for-service for prenatal visits instead of a global fee starting this summer for women due in 2027. These coding changes may increase professional maternity reimbursement and reduce cost predictability. But the overall impact on total healthcare spending is likely to be modest for most plan sponsors. The larger challenge may be uncertainty around implementation, reporting and budgeting, particularly as prenatal services related to 2027 deliveries may begin appearing under the new billing approach during 2026 and final reimbursement values aren't expected until later in the 2026 planning cycle.
The AMA has stated that the relative values assigned to these codes will be budget-neutral. Even so, actual plan experience could vary depending on how providers use the new codes and how often separately reimbursable services are billed. If providers bill for higher-intensity visits more often or utilization of separately reimbursable services increases, total maternity costs could rise above current expectations.
Proponents say that this new approach will lead to earlier prenatal visits and less missed postpartum visits. This will allow more women to be screened for depression.
What you should do now
Here are the actions you can take now to address this billing change:
- Check that your carriers are aware of and are implementing payment policies to comply with these new reimbursement rules
- Ask carriers for reporting on how these billing changes are impacting medical costs
- Seek reporting on prenatal and postpartum visits
- Be certain that changes are incorporated into budgets for 2027 and beyond
Beyond billing: Building a safer path to childbirth
Severe maternal morbidity and maternal mortality rates in the U.S. remain far higher than those in other developed countries. This is a gap these billing changes alone won't close. Actions that could make childbirth safer in the U.S. include better reporting for you and your members, encouraging early prenatal care and recommended vaccines and offering access to midwives, doulas, birth centers and mental health services.
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