What 2027 maternity changes mean for members
As implementation of the 2027 maternity coding changes approaches, one of the most common questions we’re hearing is whether the new coding structure will affect member costs.
The short answer is that the coding changes do not automatically change benefits, but they may affect how certain maternity services are processed and displayed on claims.
A closer look at preventive maternity care
Under today’s billing model, maternity care is frequently submitted as a single global claim that bundles prenatal care, delivery, and postpartum care together. Although routine antepartum and postpartum visits are generally considered preventive services under the Affordable Care Act (ACA), those services are often included within the global maternity billing package and therefore typically process under standard maternity benefits and cost-sharing.
Beginning January 1, 2027, health care providers will report maternity services separately instead of using a single global billing code. This change may allow certain routine pregnancy and postpartum visits to be identified and processed as preventive care under many non-grandfathered, ACA-compliant health plans when you receive care from an in-network provider.
Starting September 1, 2026, providers may begin billing these services separately in preparation for the new requirements taking effect January 1, 2027. Generally, this applies to members whose first prenatal visit, typically around 10 weeks of pregnancy, occurred in September or later.
Not all maternity services are preventive
It’s important to understand that the coding changes do not make all maternity services preventive.
Services such as:
- Labor management
- Delivery services
- Care for pregnancy complications
- Other non-preventive maternity services
will continue to be processed according to the plan’s maternity benefits and cost-sharing requirements.
Routine maternity care and medical office visits
Not every visit during pregnancy is considered routine antepartum care. Some visits are related to medical conditions, complications, or other concerns and are reported separately.
Routine antepartum visit
The purpose of the visit is to receive routine antepartum care, including:
- Blood pressure monitoring
- Weight monitoring
- Fetal heart tone assessment
- Fundal height measurement
- Routine chemical/dipstick urinalysis
- Psychosocial and social determinants of health screenings
- Anticipatory guidance and education
These visits typically follow the standard schedule recommended by the pregnancy care provider.
You can learn more about other pregnancy related preventive services at Healthcare.gov preventive care for women.
Medical office visit
The primary purpose of the visit is to evaluate, monitor, or treat a specific medical condition, complication, or concern. Examples include:
- Treatment for an illness unrelated to pregnancy, such as the flu or another acute illness.
- Visits focused on managing pregnancy-related complications, such as gestational diabetes. This may include reviewing blood glucose records, adjusting nutrition or exercise plans, and assessing maternal and fetal health with an OB or diabetes care team.
- Visits with a maternal-fetal medicine specialist for pregnancy complications or additional fetal monitoring and evaluation.
What members may notice
Because services will be billed individually throughout the course of a pregnancy, members may notice several changes in how maternity claims appear:
- More maternity-related claims may be submitted throughout the pregnancy rather than a single bundled claim after delivery.
- Members may receive more explanations of benefits (EOBs) as services are processed throughout pregnancy and postpartum care.
While members may see more EOBs, providers ultimately decide when and how often to submit claims (subject to timely filing requirements). Some providers may choose to bill after each visit, while others may continue to submit claims at the end of the pregnancy or follow a periodic billing schedule, such as monthly or by trimester. Because billing practices vary, the number and timing of EOBs may differ from one member to another.
What to expect next
We are working to update materials and resources to support our customers as the industry prepares for the 2027 maternity coding changes.
This transition represents a significant restructuring of maternity care coding and one of the most substantial coding changes in decades. As providers, health plans, and patients transition away from the longstanding global obstetric billing model, we recognize there may be challenges and adjustments along the way. We encourage members who have questions about these changes or about an Explanation of Benefits (EOB) they receive to contact Customer Service for assistance and support.