Episode Description
Show notes
On January 1, 2027, every global OB code your practice has billed for the last thirty years is being deleted. Seventeen CPT codes. Gone. Replaced with a completely new structure for how every dollar of maternity revenue is earned, attributed, and collected. And the real deadline for your practice is not January 1, 2027. The real deadline is right now.
What is actually going away
For over thirty years, OB practices have lived in a bundled global world: one patient, one pregnancy, one code. Effective January 1, 2027, 17 global obstetric CPT codes (including 59400 for a global vaginal delivery and 59510 for a global C-section) are being deleted entirely. The AMA and ACOG determined the global model no longer reflects modern OB standard of care, and so the structure is being fully replaced, not patched.
The four new phases of maternity billing
- Phase 1, Antepartum care. All bundled antepartum codes deleted. Every prenatal visit billed as individual E/M with TH modifier (99202 through 99215).
- Phase 2, Labor management. New dedicated code category for the first time in CPT history. Reported per calendar day, with straightforward vs complex management distinction.
- Phase 3, Delivery. Vaginal vs cesarean restructured. VBAC coded differently than first-time vaginal. Add-on procedures (3rd/4th degree laceration repair, uterine tamponade) now separately billable.
- Phase 4, Postpartum care. All existing postpartum codes deleted. Hospital care codes for inpatient day-after-delivery. Office E/M for outpatient follow-up. Same-date postpartum bundled into delivery.
Why the real deadline is Q3 and Q4 2026
Cash flow in January 2027 will be decided this Q3 and Q4. Payer contracts reference CPT codes by number, so contracts that reference deleted codes need renegotiation now. Documentation habits have to change before the new codes go live, because every prenatal visit now needs to support E/M level selection. A 200-patient OB practice undercoding prenatal visits by even $40 each is leaving close to $100,000 a year on the table from day one.
The multi-provider attribution problem
Under the global model, attribution was easy: one practice, one fee, regardless of which provider saw which visit. Under the new model, every encounter is attributed to the individual provider who performed it. Practices with midlevels, hospitalists, or shared call need a clear protocol for labor management billing, on-call coverage, and cross-coverage now, or they will either double-bill (compliance risk) or miss charges (phantom revenue) from day one.
Three actions this week
- Pull a payer contract audit. List every commercial contract referencing global OB codes that needs renegotiation before January 1.
- Run a prenatal documentation review. Pull 10 recent prenatal charts per provider and assess them against current 99213 and 99214 E/M standards. The gap is your single biggest revenue risk.
- Map your provider attribution workflow. Write out exactly how labor management, on-call coverage, cross-coverage, and same-day postpartum care will be tracked when every encounter is attributed individually.
Episode breakdown
1. The 17 deleted codes
2. The four new phases of maternity billing
3. Why Q3 and Q4 of this year is your real deadline
4. The multi-provider attribution gap
5. What patients will see on their EOBs
6. Your 90-day action plan
7. What is ahead in the rest of the OB Global Coding Series
Resources
→ Live OB Global Updates Webinar (PRIMARY): eligibility.natrevmd.com/obgyn-global-updates-webinar
→ Book a call with Heather: calendly.com/heather-natrevmd
→ Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist
→ Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3
→ Coming next in the series: EP189 — How to Bill Antepartum Care Under the New E/M Model