FAQs: CPT® 2027 coding for antepartum care (prenatal)

How is antepartum care reported under the new structure?

Antepartum care will be reported per encounter with the appropriate E/M service based on location of the patient, such as office, hospital or telehealth. Standard E/M rules apply, using Medical Decision Making (MDM) or time. 

Note: For care provided by a nonphysician qualified healthcare professional (QHP) who may not report E/M services, refer to the specific service (examples: genetic counseling or medical nutrition therapy). Antepartum and fetal invasive services procedural codes remain, and some services were relocated there.

If reporting an antepartum-only code such as 59425 or 59426, what date of service should be reported?

When reporting antepartum code 59425 or 59426, these codes should be reported when the service has concluded; in this instance, the service would be considered concluded once the number of visits the code represents has been provided to the patient. As such, the date of service to report should reflect the date of the last antepartum encounter included in that code.  

Note that third-party payer rules may vary in terms of reporting, with some requesting only the last encounter date, while others, for example, may request a date range reflecting the first and last dates of service when sending documentation. Please check with your third-party payer to determine any third-party reporting guidelines that may apply to date of service reporting.

How can payers identify pregnancy-related encounters in claims?

Use ICD-10-CM pregnancy codes (e.g., Z34- or O chapter codes) and consider HCPCS modifier TH (obstetrical treatment/services, prenatal or postpartum) where applicable to designate maternity-related services.

Will antepartum visit intensity vary across patients?

In 2027, antepartum visits will be reported individually, using E/M codes; and E/M reporting rules will apply. As with other E/M services, the specific code reported for a given encounter will be based on either total time on the date of the encounter, or Medical Decision Making (MDM); and each encounter will be evaluated for code selection based on the service provided in that particular encounter. The 2027 revisions do not assign a fixed level of complexity to a given patient across all of their antepartum encounters.  

For E/M leveling purposes, is pregnancy itself considered a chronic condition that should be counted toward the number and complexity of problems addressed, or should providers base MDM solely on pregnancy-related complications and co-existing conditions such as gestational diabetes, hypertension, obesity or advanced maternal age?

Reporting of pregnancy antepartum visits using E/M codes would follow the rules for E/M reporting, both for the base condition, and to reflect related comorbid conditions.

For the base condition: The question of appropriate categorization of a pregnancy as a “problem addressed” in the E/M structure, was answered in the June 2026 issue of CPT® Assistant, in the article "Antepartum Care: Changes for CPT 2027."  The question and answer provided is reprinted here:

"Question: Clarification is needed regarding the appropriate evaluation and management (E/M) medical decision making (MDM) level for the complexity of problems addressed for patients who are pregnant. Is pregnancy considered an acute, uncomplicated illness? The definitions in the E/M Services Guidelines section indicate that the expected duration of a chronic condition is at least 1 year; however, with postpartum care, 46 weeks is nearly a year.

Answer: Even though pregnancy is not an illness, it is a condition. For the purposes of E/M reporting, normal pregnancy may be reported with an E/M code as a “problem” addressed. Furthermore, when individual prenatal visits are reported using E/M codes (based on payer requirements), time or MDM may be used to determine the level like any other E/M encounter. A normal pregnancy is not an acute, uncomplicated illness. It is important to note that even an uncomplicated antepartum visit is not comparable to common examples of acute, uncomplicated illnesses (eg, cystitis, allergic rhinitis, simple sprain) listed in Centers for Medicare & Medicaid Services’ (CMS’s) Table of Risk.

Although a pregnancy does not last a year or more, the patient or the fetus’s condition may not be “stable.” Therefore, pregnancy best fits into the moderate category of a “chronic illness with exacerbation, progression, or side effects of treatment.”"

For comorbid conditions: E/M rules should be applied to reflect comorbid conditions that are impacting the care provided in the encounter. Per CPT guidelines, "Comorbidities and underlying diseases, in and of themselves, are not considered in selecting a level of E/M services unless they are addressed, and their presence increases the amount and/or complexity of data to be reviewed and analyzed or the risk of complications and/or morbidity or mortality of patient management." CPT guidelines also indicate that "Multiple problems of a lower severity may, in the aggregate, create higher risk due to interaction."

Important note: E/M reporting is dependent on assessing the levels of three separate elements: Number and Complexity of Problems Addressed at the Encounter, Amount and/or Complexity of Data to Be Reviewed and Analyzed, and Risk of Complications and/or Morbidity or Mortality of Patient Management. The response provided only pertains to the Problems Addressed element; proper E/M code selection requires evaluation on all three elements of service.

The midwifery model requires longer antepartum visit times to allow for client education and shared decision making. What are considerations for E/M coding when the pregnant patient is healthy and low risk (i.e., not "complex") and the provider is face-to-face for a 30-minute visit which includes evaluation of health status and risk status (including vital signs, fetal heart rate, fundal height, any lab results, etc.), and time spent on education and discussions around shared decision making? What code(s) are available and appropriate, and what are the key elements of provider documentation to support them?

When the new Maternity Care Services Guidelines become effective Jan.1, 2027, antepartum visits will be reported utilizing the E/M code appropriate for the care provided. Codes may be selected based on either MDM, or total time on the date of the encounter. The method of code selection is determined by the physician or other QHP based on what is most appropriate for that specific encounter; and the CPT code set does not determine a hierarchy in which one method supersedes another, nor any specific clinical instance in which one method or another must be used. 

If MDM is utilized, documentation should support the level decision on each of the three elements considered (problems addressed, data and risk), as well as the overall code level. For total time on the date of the encounter, CPT requires that the total time spent on the date of the encounter (versus a range), must be reported. 

Physician or other qualified healthcare professional time includes these activities, when performed:

• Preparing to see the patient (e.g., review of tests)
• Obtaining and/or reviewing separately obtained history
• Performing a medically appropriate examination and/or evaluation
• Counseling and educating the patient/family/caregiver
• Ordering medications, tests, or procedures
• Referring and communicating with other healthcare professionals (when not separately reported)
• Documenting clinical information in the electronic or other health record
• Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
• Care coordination (not separately reported)

Do not count time spent on:

• The performance of other services that are reported separately
• Travel
• Teaching that is general and not limited to discussion that is required for the management of a specific patient

While CPT only requires that total time be reported, third-party payers may request additional detail on how the time was spent.

Additional resources

• Overview: CPT® 2027 Maternity Care Services code changes
• FAQs: Preparing for the CPT® 2027 Maternity Care Services code changes
• FAQs: CPT® 2027 coding for maternity care spanning transition date 
• FAQs: CPT® 2027 coding for labor management
• FAQs: CPT® 2027 coding for delivery care
• FAQs: CPT® 2027 coding for postpartum care