On January 1, Medicare adopts the AMA’s unbundled maternity care codes. CMS released its 2027 Physician Fee Schedule final rule on November 4 without the 15 Medicare-only G-codes it had proposed in July to keep the global bundle in place. Prenatal care, labor management, delivery, and postpartum care will now be reported separately, and each prenatal and postpartum visit becomes its own evaluation and management (E/M) service.
For most OB/GYN practices, the global code has defined how a pregnancy gets paid for as long as anyone on staff can remember. One payment covered months of visits, the delivery, and the follow-up care. Nobody had to look closely at how each piece of that episode ran, because no piece was paid on its own. In January, practices start looking at the prenatal episode visit by visit, and for the first time in decades, nearly every part of it is up for review.
What changes for OB/GYN practices on January 1
The 2027 CPT update retires the global obstetric codes and moves maternity care to service-level reporting across four phases: antepartum, labor management, delivery, and postpartum. In total, the update deletes 17 codes, adds 12 codes, and revises six codes. The deleted codes include the global packages most billing teams know by heart, including 59400, 59510, and 59610.
Several practical changes follow from that structure:
- Every prenatal and postpartum visit is billed as its own E/M service, with its own complexity level and its own documentation requirement.
- Advanced practice providers and midwives bill their own visits. Under the global code, the physician received credit for the whole episode.
- Labor management becomes separately reportable, which matters especially for practices that use laborists or OB hospitalists.
- Pregnancies that cross the new year follow a transition rule. According to ACOG, HHS will let health plans keep using the 2026 codes for pregnancies that begin in 2026 and end in 2027.
- Medicare sets the benchmark, and every other payer sets its own terms. Medicaid programs and commercial plans decide their own rates and timelines, though many reference Medicare Physician Fee Schedule RVUs as a benchmark for clinician reimbursement.
The new codes arrive alongside a payment cut. For most physicians, the 2027 Medicare conversion factor drops 2.31%, to $32.63. Practices that pay physicians on work RVUs face an additional question about how the restructured codes affect individual productivity, which compensation advisors such as PYA have begun modeling.
Each piece of prenatal care now needs an owner
The global code let a practice treat a pregnancy as one financial event. The operating decisions inside that event, such as how a visit was documented, who saw the patient, and how long labor management took, had no separate effect on payment, so they rarely got examined.
That ends in January. Each prenatal visit needs documentation that supports a standalone E/M level. Visits by APPs and midwives are attributed to the clinician who performed them. Payer contracts that reference the deleted global codes need review, and billing systems need the new codes loaded and tested before the first claim goes out.
MGMA’s transition checklist for OB/GYN practices covers this work well: count the pregnancies crossing January 1 by payer, get payer transition policies in writing, audit documentation, review contracts and vendor readiness, and set baseline revenue cycle metrics before the change. Every step on that list concerns services the practice bills itself. Prenatal lab testing doesn’t appear on it, because the practice typically isn’t the one billing for it.
Louri Roberts, Director of Client Services
“With any significant coding policy change, the insurers may adopt the new coding method at different rates under different rules. In general, if a pregnancy starts in 2026 and continues into 2027, insurers likely will split the billing: 2026 care uses the old global codes, and 2027 visits use the new phase-specific codes. Any pregnancy that starts in 2027 is to use the new phase-based codes from the beginning of the pregnancy. To prevent claim denials, it is a good idea to reach out to your common payors to verify how they are adjusting to this change.”Genetic prenatal lab tests never ran through the practice’s bundle, but they could be a 2027 billing strategy
The global fee paid for the obstetrician’s professional services. The testing that runs alongside those visits, from the initial prenatal panel to carrier screening and cell-free DNA screening, typically goes to a reference laboratory, and the reference laboratory bills for it. The reimbursement on that testing follows the specimen out of the practice.
Unbundling restructures how a practice reports its own services. It leaves the lab arrangement exactly where it was. In a year when the rest of the prenatal episode is being recoded, re-documented, and recontracted, the practice will still be running on the same lab testing arrangement it had in 2026.
That arrangement persists because most OB/GYN practices do not have an in-house genetic laboratory, and the reference lab model is often seen as the only other option. Running lab reimbursement any other way requires infrastructure that most practices can’t reasonably assemble and manage on their own, so the alternative rarely reaches the agenda. However, OB/GYN practices across the nation are running alternative billing strategies that make their lab testing run as a practice asset.
See: OBGYN Profitability Opportunities from Lab Testing
Before deciding anything about its lab arrangement, practice leadership needs a clear view of where prenatal testing stands today. Three questions give that view:
1. What share of the practice’s OB patients are covered by commercial plans, and which plans?
2. Which prenatal and genetic tests does the practice order, at what volume, and where do they go today?
3. Who owns lab billing questions now, from claims to patient calls, if anyone does?
Genetic prenatal lab testing should be added to the 2027 billing review
The 2027 transition is forcing OB/GYN practices to examine the prenatal episode service by service, many for the first time. The review is already underway: documentation, attribution, contracts, payer policies, baselines.
Genetic prenatal lab testing presents as one area for potential practice growth, and it belongs on leadership’s agenda for 2027 as OB/GYN practices plan for revenue and coding changes.
Phytest is the fully managed lab partner for 65+ OB/GYN practices. We can help your team review it’s existing lab activity and determine if you may have an opportunity to capture the value from those lab tests.
