The End of the Global OB Package: AMA's 2027 CPT Overhaul Unbundles Maternity Care Payment

The American Medical Association has released a significant restructuring of maternity care CPT coding that will replace the traditional bundled global obstetric payment model beginning January 1, 2027. These changes are expected to affect how obstetric providers, hospitals, payors, billing vendors, and managed care organizations document, bill, adjudicate, and contract for maternity care services. Clients should begin assessing payor contracts, billing systems, clinical documentation workflows, provider compensation models, and revenue-cycle policies now to prepare for the transition. This alert outlines the key coding changes, the resulting risks, and recommended next steps for affected organizations. 

The Current Global Obstetric Package

For decades, routine maternity care has generally been billed using global obstetric CPT codes that bundle antepartum care, delivery, and postpartum care into a single payment when the same provider or group furnishes the full episode of care. This payment methodology assumes a standardized pregnancy episode, including routine prenatal visits, labor and delivery management, delivery services, and postpartum follow-up. Because payment is not tied to the specific services rendered, this bundled structure also limits insight into true utilization, quality, and cost of care. Under this structure, providers also typically absorb the cost for months of care before receiving any reimbursement. 

Maternity care delivery, however, has evolved considerably. Care is increasingly team-based, drawing on multiple specialized provider types spanning a range of service settings, including telehealth and home monitoring. It also commonly incorporates risk-stratified prenatal schedules and expanded postpartum monitoring for high-risk conditions that are growing more prevalent, such as hypertension, behavioral health concerns, hemorrhage risk, and cardiac complications.

Key CPT Code Changes

The new maternity care coding structure is intended to replace the global obstetric payment framework with more granular reporting of maternity care. Based on the AMA’s early release of maternity care services codes and related guidance, the revised framework will generally separate antepartum care, labor management, delivery care, and postpartum care rather than rely on one global code for the full episode.

• Antepartum care: Prenatal encounters are expected to be reported using the appropriate evaluation and management code for the site and nature of service, rather than legacy antepartum package codes.
• Labor management: Labor management will be separately reportable and may be differentiated by the complexity and timing of care.
• Delivery services: Delivery codes will be streamlined by birth type, reported separately from labor management, and expanded to include distinct codes for certain high-risk procedures.
• Postpartum care: Postpartum encounters are expected to be reported separately, reflecting the growing clinical importance of postpartum surveillance and follow-up.
• Ancillary and related services: Services such as ultrasounds, laboratory testing, genetic counseling, nutrition therapy, and care for surgical complications of pregnancy may continue to require separate coding analysis depending on the circumstances and payor rules.

Why This Matters 

The shift away from global maternity billing is more than a coding update. It will change how maternity care is valued, documented, billed, audited, and reimbursed. Organizations that continue to rely on legacy global-payment assumptions may face claim denials, delayed reimbursement, coding inconsistencies, inaccurate revenue projections, and contract-interpretation disputes.

Providers and payors should also expect the transition to raise operational questions about how maternity episodes are attributed when care is divided among physicians, certified nurse-midwives, maternal-fetal medicine specialists, laborists, hospitals, freestanding birth centers, telehealth providers, and postpartum care teams. These issues may be particularly important for organizations that use value-based care arrangements, episode-based payment models, shared-savings structures, or provider compensation formulas tied to delivery volume or global obstetric payments.

Contracting and Compliance Considerations

Preparing for the transition touches several operational areas, from contract language to compensation design. Organizations should review the following: 

• Managed care agreements: Review contracts that reference global obstetric codes, maternity case rates, delivery-only codes, postpartum care obligations, bundled payment methodologies, or payor-specific maternity policies. Amendments may be needed to align reimbursement terms with the new CPT structure.
• Billing and coding policies: Update charge capture tools, superbills, electronic health record templates, claim edits, payor-specific coding guidance, and revenue-cycle workflows before the effective date.
• Documentation standards: Ensure clinical documentation supports separate reporting of antepartum visits, labor management, delivery services, postpartum care, medical decision-making, time-based services, complexity, and separately billable services.
• Compliance and audit risk: Develop internal controls to prevent inappropriate unbundling, duplicate billing, unsupported E/M coding, and inconsistent coding across providers and sites of service.
• Provider compensation: Evaluate physician and advanced practice provider compensation plans that rely on work relative value units, delivery volume, global OB codes, or maternity case-rate assumptions.
• Value-based care and quality programs: Assess how the new codes may affect episode definitions, attribution, risk adjustment, maternity quality metrics, postpartum follow-up measures, and cost-of-care benchmarks.

Recommended Next Steps

Organizations can begin managing this transition now by taking the following steps: 

1. Inventory affected agreements. Identify commercial payor, Medicaid managed care, employer direct-contracting, provider employment, professional services, and value-based care agreements that reference global maternity payments or legacy obstetric CPT codes.
2. Model financial impact. Compare current reimbursement under global obstetric codes with anticipated reimbursement under component-based billing, including possible changes in visit volume, labor management coding, postpartum care, and payor fee schedules.
3. Engage payors early. Seek written payor guidance on transition timing, fee schedules, claim submission rules, modifier requirements, prior authorization expectations, and treatment of care spanning the effective date.
4. Update revenue-cycle infrastructure. Modify billing systems, claim edits, provider templates, coding education, denial-management protocols, and internal audit plans. The new model will increase provider and payor administrative overhead.
5. Train clinical and billing teams. Provide targeted education to obstetric providers, midwives, coders, billers, compliance personnel, and contract managers on the new coding framework and documentation expectations.
6. Monitor federal and payor guidance. Track the final CPT 2027 codebook, payor bulletins, Medicaid program updates, and any state-specific reimbursement guidance that may affect implementation. 

The unbundling of maternity care CPT coding represents a major operational and reimbursement change for the health care industry. Although the revised codes are not expected to take effect until January 1, 2027, organizations should treat 2026 as an implementation year. Early contract review, payor engagement, documentation planning, and revenue-cycle preparation will be critical to reducing reimbursement disruption and compliance risk. 

Please contact one of the authors of this article with questions.