FAQs: CPT® 2027 coding for maternity care spanning transition date

Can you review the transition from global obstetric (OB) charges to E/M charging as of 2027: Will some patients have both a global fee closing out the 2026 care and then E/M billing to complete their pregnancy care? For example, how should activity be reported if we see a patient in 2026 for five antepartum visits and also provide antepartum visits in 2027 up until they deliver?

From a CPT reporting perspective, for patients receiving antepartum care services in both 2026 and 2027, CPT codes would be reported in both calendar years.

For antepartum visits occurring in the 2026 calendar year:

• Patients with four or more antepartum visits in the 2026 calendar year would have those visits reported using CPT codes 59425 (for 4-6 visits) or 59426 (for 7 or more visits).
• Patients with three or fewer antepartum visits in the 2026 calendar year should have those visits reported using individual E/M codes, one for each encounter.
• This guidance is currently provided in CPT® 2026 Professional Edition for the reporting of antepartum visits.

For antepartum visits occurring in the 2027 calendar year:

• All of those encounters will be reported using the E/M code most appropriate to the service provided.

For the scenario noted in the question, code 59425 would be reported for the five visits in 2026, and individual E/M codes would be reported for antepartum encounters provided in 2027.

In addition to this CPT reporting guidance, users should check with their third-party payers to confirm any additional payer policies on the transition for antepartum care service reporting. 

Do we change to E/M coding for antepartum patients who are pregnant now and due after Jan. 1, 2027, or not until the new year?

Per CPT guidelines, the new guidelines for reporting maternity care do not change until Jan. 1, 2027. Therefore, any antepartum care provided to a patient in 2026 will still fall under the 2026 reporting codes and guidelines.

In CPT 2026 Professional Edition, an instruction provided with the antepartum care only codes (59425 and 59426) states: "For 1-3 antepartum care visits, see appropriate E/M codes." This guidance still holds for the remainder of calendar year 2026 activity.

Put another way: For 2026, only report E/M codes for antepartum encounters if there are three or fewer antepartum encounters occurring in calendar year 2026. Using E/M to report all antepartum activity, regardless of the total number of visits in a calendar year, will not begin until on or after Jan. 1, 2027.  Check with your third-party payers to confirm any special policies on the transition for antepartum care service reporting.

If the due date is on or after Jan. 1, 2027, can we start billing E/M codes for prenatal visits in 2026? 

In order to bill E/M services for antepartum care based on CPT 2026 coding guidelines, the routine visits have to equal 3 or fewer.  

While not specified within CPT reporting guidelines, for the 2026–2027 transition it is recommended that antepartum care claims reported with E/M codes be submitted for payment as soon as there is certainty on the volume of completed routine calendar year 2026 antepartum encounters. While this may result in a slight delay on some claim submissions, the practice should reduce the possibility of needing to submit a high volume of amended claims if volumes change last-minute, while remaining within the vast majority of requirements for timely filing (90 days), presuming that the longest interval between routine antepartum encounters is one month or less.  

Documentation for all prenatal visits for due dates on or after Jan. 1, 2027, should include medical decision making and/or time to meet E/M documentation requirements so that the correct E/M code may be selected if necessary.

For 1–2 routine encounters: Submit claims at the conclusion of the last encounter. 

For 3 encounters: Submit claims at the conclusion of the last encounter. 

For 4–6 routine encounters: Report code 59425, Antepartum care only; 4–6 visits, at the conclusion of the last encounter. 

Please note: Other non-routine encounters occurring during the antepartum period are not included in the encounter counts listed and are coded and reported separately. 

For patients delivering in 2027, should we bill 2026 antepartum visit codes at the end of the year 2026 or when the patient delivers? 

You should code for antepartum services at the end of 2026 or early 2027. It is not required that billing be held until the patient delivers.  

Does the 2026–2027 antepartum transition mean that the patients’ last antepartum visit in 2026 would be reported with 59425/59426 based on number of visits? 

There are three potential options for reporting antepartum care only at the end of 2026 for a patient who will not deliver until 2027. For 3 or less antepartum visits report each with an appropriate E/M service. When there are 4–6 visits report 59425 and for 7 or more visits, report 59426.   

For current ICD-10 coding guidelines, it is stated that no O codes can be used with a Z34.__ code. For antepartum services in 2027, should we be using both the Z34.__ code with O codes, or should we be reporting O codes only followed by the Z3A.__ code for the weeks of gestation? 

Per ICD-10-CM Official Guidelines for Coding and Reporting, “Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist (a routine prenatal visit or postpartum care)...Z34, Encounter for supervision of normal pregnancy… should not be used in conjunction with chapter 15 [Pregnancy, Childbirth, and the Puerperium O00-O9A]...Codes in category Z3A, Weeks of gestation, may be assigned to provide additional information about the pregnancy.” ¹

From Section I.C.15.b.1—Selection of OB Principal or First-listed Diagnosis - Routine outpatient prenatal visits: "For routine outpatient prenatal visits when no complications are present, a code from category Z34, Encounter for supervision of normal pregnancy, should be used as the first-listed diagnosis. These codes should not be used in conjunction with chapter 15 codes" (Pregnancy, Childbirth, and the Puerperium O00-O9A).

From Section I.21.C.11—Encounters for Obstetrical and Reproductive Services: "Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist (a routine prenatal visit or postpartum care). Codes in category Z34, Encounter for supervision of normal pregnancy, are always first listed and are not to be used with any other code from the OB chapter. Codes in category Z3A, Weeks of gestation, may be assigned to provide additional information about the pregnancy. Category Z3A codes should not be assigned for pregnancies with abortive outcomes (categories O00 O08), elective termination of pregnancy (code Z33.2), nor for postpartum conditions, as category Z3A is not applicable to these conditions." 

Scenario: Labor management started on Dec. 31, 2026. The patient is admitted that day and delivers on Jan. 1, 2027. How will this be reported? 

CPT reporting in this scenario depends on whether the labor management performed on Dec. 31 and Jan. 1 is continuous. Per the CPT 2027 Maternity Care Services guidelines for Labor Management reporting,  “a continuous visit (ie, requiring continuous personal physician or other QHP attendance at bedside or elsewhere on the floor or unit focused on a single parturient) that spans the transition of two calendar dates is a single service and is reported as a single service on one of the two calendar dates.”  

If the labor management provided meets the criteria for a continuous visit between Dec. 31 and Jan. 1, the initial labor management code (59080 for straightforward, or 59081 for complex, as appropriate) could be reported as a single service on Jan. 1, 2027.

If the labor management provided does not meet the criteria for a continuous visit, Dec. 31 activity could potentially be reported using an Initial Hospital inpatient or observation E/M code, 99221-99223; note that these codes may be reported using either Medical Decision Making, or total time on the date of service.  It is strongly advised to contact your payer in this second scenario, to understand if there are any additional third-party payer guidelines that may apply in this rare instance.  

How should we code a delivery that takes place in November or December 2026 with postpartum care in 2027? 

Since the delivery does take place in 2026 and at that time you may bill the appropriate 'global' code based on delivery method, you would report a “global” code (e.g., 59400) regardless of postpartum care taking place in 2027. Any postpartum services that are performed on or after Jan. 1, 2027, could be reported with the appropriate E/M code.

¹ICD-10-CM Official Guidelines for Coding and Reporting, https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf. Accessed Sept. 11, 2026.

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 antepartum care (prenatal)
• FAQs: CPT® 2027 coding for labor management
• FAQs: CPT® 2027 coding for delivery care
• FAQs: CPT® 2027 coding for postpartum care