How it works today
Right now, most pregnancy care is billed like a prepaid bundle. The practice sends one bill that covers months of prenatal checkups, the delivery and the follow-up visits after birth.
It is a bit like paying one price for a vacation package instead of paying separately for the flight, hotel and meals.
That works fine when one practice sees the patient from start to finish. It gets messy when a patient switches doctors halfway through, moves away, or needs far more visits than usual because of a high-risk pregnancy.
What's changing
The medical billing codes doctors use (called CPT codes, maintained by the American Medical Association) are being rewritten for 2027:
- Prenatal care, labor, delivery and after-birth care will each be billed separately.
- Every prenatal and postpartum visit becomes its own regular office visit on the bill.
- Each visit can be billed at a different level, based on how complex it was.
Overall, 17 old codes are being removed, 12 new ones added and 6 revised.
The catch: Medicare hasn't decided yet
Medicare proposed using the new codes, but it also floated keeping a bundled version of its own.
Its final decision is expected in the 2027 Physician Fee Schedule, which usually comes out in early November. So practices may end up following one set of rules for Medicare and another for private insurers and Medicaid.
Decided in the 2027 Physician Fee Schedule final rule.
Watch for insurer letters in December.
- NowMedicare has proposed, not decided
- November2027 Physician Fee Schedule expected
- January 1, 2027New codes take effect
What it means for your practice
Possibly fairer pay
Practices that see patients for only part of a pregnancy, or for many extra visits, may be paid more accurately.
More billing work
Instead of one claim, there will be many. Mistakes or missing notes could mean lost payments.
Notes matter more
Because each visit is paid by its complexity, what the doctor writes down affects what the practice is paid.
What to do now
Not sure your billing is ready for January?
Our medical billing and medical coding teams can review your setup before the new codes take effect.