2027 maternity billing · standardized biller rubric

248rubric rows

84payer source documents

228rows with explicit billing guidance

22rows naming Category II codes

32sources with contact or follow-up

Rubric generated 2026-10-08 · Directory current as of 2026-10-08 · Cells read “not provided” when the payer document is silent.

How to read this rubric

One row per payer instruction, in the payer's own words.

Each row states the conditions a payer attached to an instruction (visit date, delivery date or EDD, visit number, service phase), what to bill and what not to bill, and the verbatim passage it was taken from. Nothing is inferred from general CPT guidance: if a document does not name a modifier, diagnosis rule, Category II code or contact, the cell says so. Use the policy directory for each plan's overall status and source links.

248rubric rows

84source documents

228rows with explicit billing guidance

22rows naming Category II codes

239rows tied to a directory plan

32sources with contact or follow-up

Every row is extracted from one payer document (generated 2026-10-08; each quote verified against the retrieved text). A cell reads not provided when the document is silent, Inferred when the reading is not stated verbatim, and Category II codes appear only where the document lists them. The plans column is resolved against the current policy directory, so plans removed or re-labelled by the directory review are reflected here.

SearchSource documentGuidanceDirectory plans

248 rows

Directory plans	Payer	Product / Line of business	Visit Date	Delivery Date (EDD)	Visit Number	Visit Type	Service Phase	Billing Decision	Codes to bill	Modifier	Diagnosis requirement	Category II CPT required	Codes NOT to bill	Cost Share	Obligation	Guidance	Effective / published	Instruction status	Payer contact	Further guidance promised	Source	Verbatim source text
In directory 1/1 plan published	Aetna Better Health of Florida	Medicaid	>= 1/1/2027 (DOS)	Any	Any	Any	All	Global OB bundling ends; itemized coding - coding and claims-edit details not finalized	not provided	not provided	not provided	not provided	Global maternity codes (from 1/1/2027)	not provided	will	Provided (date only; billing rules not provided)	Effective 1/1/2027	awareness; operational details pending	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	D03https://ch.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_End_of_OB_Bundled_Billing.pdfverified 2026-09-07	“Effective January 1, 2027, the AMA will eliminate traditional global maternity CPT codes and replace them with a more granular, itemized framework”
In directory 1/1 plan published	Aetna Better Health of Florida	Medicaid	< 1/1/2027	Any	Any	Any	All	not provided	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	D03https://ch.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_End_of_OB_Bundled_Billing.pdfverified 2026-09-07	not provided
Some plans in directory 1/21 plans published	Cigna Healthcare	Commercial (provider newsroom)	>= 9/1/2026 (initial prenatal visit)	Any	Any	Routine prenatal	Antepartum	Continue current contractual maternity billing (global); do NOT submit the ACOG/AMA-recommended prenatal E/M codes because of the 9/1/2026 date	Existing contracted maternity codes	not provided	not provided	not provided	Prenatal E/M codes submitted solely due to first visit on/after 9/1/2026	not provided	must (do not)	Provided	Published 2026-08-24	current policy maintained; 2027 guidance promised later in 2026	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	D04https://providernewsroom.com/cigna-healthcare/update-on-maternity-coding-and-reimbursement/verified 2026-09-07	“not changing its current maternity billing guidance at this time”
Some plans in directory 1/21 plans published	Cigna Healthcare	Commercial (provider newsroom)	>= 1/1/2027 (DOS)	Any	Any	Any	All	Not yet issued - additional guidance promised	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	pending	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	D04https://providernewsroom.com/cigna-healthcare/update-on-maternity-coding-and-reimbursement/verified 2026-09-07	not provided
Some plans in directory 1/10 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	>= 9/1/2026	Any	Any	Prenatal or postpartum	Antepartum / Postpartum	E/M 99202-99215 + TH (encouraged, not required)	99202-99215	TH	not provided	not provided	not provided	not provided	encouraged (may)	Provided	Bulletin 2026-07-10; encouragement from 9/1/2026	operational (permissive)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use Evaluation and Management codes (E/M 99202-99215) with the TH modifier, to indicate prenatal or postpartum care.”
Some plans in directory 1/10 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	< 1/1/2027 (DOS)	Any	Any	Any	All	Global/bundled codes remain acceptable; health plans may not require individual E/M in lieu of bundled codes	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	may	Provided	Bulletin 2026-07-10	operational	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“health plans may not require the use of individual E/M codes in lieu of current bundled codes for dates of service prior to Jan. 1, 2027.”
Some plans in directory 1/10 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	>= 1/1/2027 (DOS)	Any	Any	Any	All	All current maternity codes incl. global deleted from fee schedule; use new AMA codes	New AMA maternity codes (not enumerated)	not provided	not provided	not provided	All current maternity service codes incl. global	not provided	will	Provided (codes not enumerated)	Effective 1/1/2027	operational (announced)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule and the new maternity billing codes, released by the American Medical Association (AMA), will become effective as of this date.”
Some plans in directory 1/17 plans published	Michigan Medicaid (MDHHS)	Medicaid (provider alert to all providers)	<= 12/31/2026 (DOS)	Any	Any	Routine maternity	All	Adhere to current MDHHS Medicaid Provider Manual policy (global codes)	Current global codes per manual	not provided	not provided	not provided	not provided	not provided	required	Provided	Alert 2026-07-15	current policy	not provided	September 2026 - policy bulletin for public comment	D06https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/medicaid-providers/medicaid-provider-alerts/all-alerts-and-updates/july-15-2026-maternity-care-servicesverified 2026-09-07	“For routine maternity care services provided on and before December 31, 2026, providers are required to adhere to current Medicaid policy as outlined within the MDHHS Medicaid Provider Manual”
Some plans in directory 1/17 plans published	Michigan Medicaid (MDHHS)	Medicaid (provider alert to all providers)	>= 1/1/2027 (DOS)	Any	Any	Routine antepartum / postpartum	All	Separate CPT reporting incl. E/M for routine antepartum and postpartum; policy bulletin for comment due September 2026	E/M and separate CPT codes (not enumerated)	not provided	not provided	not provided	Global maternity codes	not provided	will	Provided (bulletin pending)	Effective 1/1/2027	announced; operational details pending	not provided	September 2026 - policy bulletin for public comment	D06https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/medicaid-providers/medicaid-provider-alerts/all-alerts-and-updates/july-15-2026-maternity-care-servicesverified 2026-09-07	“MDHHS will transition to the reporting of separate CPT codes, including the use of evaluation and management (E/M) codes for routine antepartum and postpartum care, for all dates of service occurring on and after January 1, 2027.”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027 (and/or with visit date)	Any	Routine prenatal	Antepartum	E/M + TH; pregnancy-related O or Z ICD-10 on all prenatal visits; 0500F on initial prenatal visit	E/M 99202-99215, 99341-99350, 99417 (+0500F initial visit)	TH	Pregnancy-related O or Z ICD-10 on every prenatal visit	Required: 0500F on the initial prenatal visit ('initial prenatal visits must include the Category II CPT code 0500F')	59400, 59425, 59426, 59510, 59610, 59618 when service dates include >= 1/1/2027	not provided	directs (must)	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“directs all NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services to use the below for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	< 6/1/2026 (prenatal care established)	<= 12/31/2026 (implied by 'through December 31, 2026')	Any	Routine prenatal	All	Current billing guidance (global) applies through 12/31/2026	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	applies	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“For services provided to NYS Medicaid members who have established prenatal care prior to June 1, 2026, current billing guidance applies through December 31, 2026.”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 1/1/2027 (DOS in span)	Any	Any	Any	All	Bundled/global codes unavailable; further Medicaid Update articles promised for 2027 codes	not provided	not provided	not provided	not provided	59400, 59425, 59426, 59510, 59610, 59618	not provided	will	Provided (deletions only; 2027 codes not provided)	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational (deletions) / pending (2027 codes)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“Bundled/Global CPT codes that will be deleted and unavailable when service dates include dates on or after January 1, 2027”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027 (and/or with visit date)	Any	Routine prenatal	Antepartum	E/M + TH; pregnancy-related O or Z ICD-10 on all prenatal visits; 0500F on initial prenatal visit	E/M 99202-99215, 99341-99350, 99417 (+0500F initial visit)	TH	Pregnancy-related O or Z ICD-10 on every prenatal visit	Required: 0500F on the initial prenatal visit ('initial prenatal visits must include the Category II CPT code 0500F')	59400, 59425, 59426, 59510, 59610, 59618 when service dates include >= 1/1/2027	not provided	directs (must)	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“directs all NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services to use the below for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	< 6/1/2026 (prenatal care established)	<= 12/31/2026 (implied by 'through December 31, 2026')	Any	Routine prenatal	All	Current billing guidance (global) applies through 12/31/2026	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	applies	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“For services provided to NYS Medicaid members who have established prenatal care prior to June 1, 2026, current billing guidance applies through December 31, 2026.”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 1/1/2027 (DOS in span)	Any	Any	Any	All	Bundled/global codes unavailable; further Medicaid Update articles promised for 2027 codes	not provided	not provided	not provided	not provided	59400, 59425, 59426, 59510, 59610, 59618	not provided	will	Provided (deletions only; 2027 codes not provided)	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational (deletions) / pending (2027 codes)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“Bundled/Global CPT codes that will be deleted and unavailable when service dates include dates on or after January 1, 2027”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield (New York)	Medicaid (article tagged Medicaid; 'Medicaid coverage provided by Anthem Blue Cross and Blue Shield HP')	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	Use the restructured (2027) coding system for this cohort; refer to NYS Medicaid Update April 2026 (D32) for the E/M+TH / O-Z dx / 0500F detail - the Anthem article itself does NOT contain the E/M+TH wording	Restructured maternity codes per NYS Medicaid Update (not enumerated in article)	not provided in article (TH is in NYS Medicaid Update D32)	not provided in article (O/Z dx is in D32)	not provided	Global/bundled OB codes for 2027 service dates	not provided	directed (must)	Provided (by reference to D32)	Published 2026-06-01 (updated 06-18); effective 1/1/2027 restructuring	operational (defers to NYS Medicaid Update April 2026)	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	D10https://providernews.anthem.com/new-york/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30315verified 2026-09-07	“All NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services are directed to use the restructured coding system for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027. Providers should refer to NYS Medicaid Update - April 2026 Volume 42 - Number 5 for additional billing guidance.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield (New York)	Commercial / Medicare Advantage	Any	Any	Any	Any	All	Not addressed - article is Medicaid-specific	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	D10https://providernews.anthem.com/new-york/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30315verified 2026-09-07	not provided
In directory 5/5 plans published	Highmark Blue Cross Blue Shield of Western New York	MMC, HARP, CHPlus, Essential Plan ONLY ('specific to the MMC, HARP, CHPlus, and EP programs only')	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	Use the restructured (2027) coding system for this cohort; refer to NYS Medicaid Update April 2026 (D32) for the E/M+TH / O-Z dx / 0500F detail - the Highmark article itself does NOT contain that wording	Restructured maternity codes per NYS Medicaid Update (not enumerated in article)	not provided in article (TH is in NYS Medicaid Update D32)	not provided in article (O/Z dx is in D32)	not provided	Global/bundled OB codes for 2027 service dates	not provided	directs (must)	Provided (by reference to D32)	Published 2026-06-01 (updated 06-18)	operational (defers to NYS Medicaid Update)	Provider Services 1-866-231-0847	not provided	D26https://providernews.mybcbswny.com/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30316verified 2026-09-07	“this information is specific to the MMC, HARP, CHPlus, and EP programs only”
In directory 5/5 plans published	Highmark Blue Cross Blue Shield of Western New York / Northeastern New York	Commercial / Medicare Advantage	Any	Any	Any	Any	All	Not addressed - see Highmark enterprise awareness notice (D23)	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	Provider Services 1-866-231-0847	not provided	D26https://providernews.mybcbswny.com/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30316verified 2026-09-07	not provided
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	>= 6/1/2026 (routine prenatal visits initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	E/M + TH with pregnancy-related O or Z ICD-10; do not rely on bundled antepartum/global codes for 2027 DOS	Appropriate E/M	TH	Pregnancy-related O or Z ICD-10	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	Bundled antepartum / global codes for DOS >= 1/1/2027	not provided	must	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational (reimbursement policy)	not provided (refers to provider contract)	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Healthfirst providers must follow updated prenatal billing requirements for: Routine prenatal visits initiated on or after June 1, 2026 and/or Pregnancies with an estimated due date (EDD) on or after January 1, 2027.”
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	< 6/1/2026 (prenatal care began)	<= 12/31/2026	Any	Routine prenatal	All	Legacy global billing may apply if all global package requirements met by one provider/group	Global package codes	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	not provided	not provided	may	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Because prenatal care was initiated before June 1, 2026, and delivery occurs in 2026, the legacy global approach may still be used if the provider or provider group delivered all components of care.”
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	>= 1/1/2027 (DOS)	Any	Any	Any	Labor management / Delivery / Postpartum	Global package codes not recognized; labor management 59080-59083 separately reportable; new OB management codes introduced	59080, 59081, 59082, 59083 (labor management); new 2027 codes	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	Global obstetrical package codes	not provided	will	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Global obstetrical package codes will no longer be recognized for reimbursement.”
In directory 1/1 plan published	Healthfirst (New York)	MMC and HARP only	Any	Any	Initial prenatal visit	Routine prenatal	Antepartum	Continue separate informational reporting of 0500F or 0503F (Category II)	0500F / 0503F	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	not provided	not provided	must	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“For MMC and HARP, continue separate informational reporting of 0500F or 0503F.”
In directory 2/2 plans published	Independent Health (NY)	ALL products: Commercial, Medicare, State Programs, Self-Funded (applied 6/1/2026 to all products)	>= 6/1/2026 (antepartum care initiated) and/or	>= 1/1/2027 ('expected delivery date')	Any	Routine antepartum	Antepartum	Each prenatal visit as E/M + TH + pregnancy-related O/Z ICD-10; 0500F on initial antepartum visit; 59425/59426 denied	E/M (ex. 99202-99215) per visit + 0500F initial visit	TH	Pregnancy-related O or Z ICD-10	Required: 0500F on the initial antepartum visit claim ('Submit 0500F (Category II code) on the initial antepartum visit claim')	59425, 59426 (denied for members initiating care >= 6/1/2026)	not provided	must	Provided	SCOPE June 2026; effective 6/1/2026	operational	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	D29https://www.independenthealth.com/providers/whats-new/scope-newsletter/2026/june-2026verified 2026-09-07	“For members initiating antepartum care on or after June 1, 2026, antepartum care codes 59425 and 59426 will no longer be reimbursable for antepartum services; if submitted, the claim line will be denied.”
In directory 2/2 plans published	Independent Health (NY)	ALL products: Commercial, Medicare, State Programs, Self-Funded (applied 6/1/2026 to all products)	Any	Any	Any	Non-routine E/M outside routine antepartum care	Antepartum	Bill E/M without modifier TH	E/M	none (no TH)	not provided	not provided	TH on non-routine visits	not provided	must	Provided	SCOPE June 2026	operational	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	D29https://www.independenthealth.com/providers/whats-new/scope-newsletter/2026/june-2026verified 2026-09-07	“E/M visits outside of routine antepartum care are billed without Modifier TH”
Some plans in directory 1/2 plans published	Anthem Blue Cross (California)	Medi-Cal Managed Care ONLY	Any	Any	Any	Any	All	Bill antepartum, delivery and postpartum as individual services; global OB codes not reimbursed (unless contract/state/federal/CMS requires otherwise)	Individual antepartum / delivery / postpartum codes (not enumerated)	not provided	not provided	not provided	Global obstetrical codes	not provided	must	Provided	Policy G-14001 effective 10/23/2025 (individual-only rule since 08/07/2020)	current policy; no CPT 2027 content	not provided	not provided	D08https://providers.anthem.com/docs/gpp/california-provider/CA_CAID_RP_maternity_services.pdf?v=202606161403verified 2026-09-07	“Providers must bill antepartum care, deliveries, and postpartum care as individual services.”
No plan in directory	Anthem Blue Cross (California)	Commercial ONLY	Any	Any	Any	Any	All	Global OB code once per pregnancy when one provider/TIN furnishes all antepartum, delivery and postpartum care; otherwise bill only the components provided	Global obstetrical codes (e.g. 59400, 59510) or component codes	not provided	not provided	not provided	Global code when the provider/TIN did not furnish all components	not provided	allows	Provided	Policy C-19004 last approved 10/01/2025, effective 01/01/2026	current policy; no CPT 2027 content (references CPT 2024)	not provided	not provided	D38https://www.anthem.com/content/dam/digital/docs/anthembluecross/provider/commercial/policy/reimb/C-19004-CA.pdfverified 2026-09-07	“If a provider or provider group reporting under the same TIN does not provide all antepartum, delivery and postpartum services, global obstetrical codes may not be used.”
No plan in directory	Anthem Blue Cross (California)	Medicare Advantage ONLY	Any	Any	Any	Any	All	Global OB code once per pregnancy (279 days) when one provider/TIN furnishes all components; otherwise bill components	Global obstetrical codes or component codes	not provided	not provided	not provided	Global code when care is split across TINs	not provided	allows	Provided	Policy G-14001 last approved/effective 10/23/2025	current policy; no CPT 2027 content	not provided	not provided	D39https://www.anthem.com/content/dam/digital/docs/provider/commercial/policy/reimb/75978mupenmub.pdfverified 2026-09-07	“The health plan allows reimbursement for global obstetrical codes once per period of a pregnancy (defined as 279 days) when appropriately billed by a single provider or provider group reporting under the same federal Tax Identification Number (TIN)”
Some plans in directory 1/2 plans published	Anthem Blue Cross (California)	Medi-Cal Managed Care	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D08https://providers.anthem.com/docs/gpp/california-provider/CA_CAID_RP_maternity_services.pdf?v=202606161403verified 2026-09-07	not provided
No plan in directory	Anthem Blue Cross (California)	Commercial	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D38https://www.anthem.com/content/dam/digital/docs/anthembluecross/provider/commercial/policy/reimb/C-19004-CA.pdfverified 2026-09-07	not provided
No plan in directory	Anthem Blue Cross (California)	Medicare Advantage	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D39https://www.anthem.com/content/dam/digital/docs/provider/commercial/policy/reimb/75978mupenmub.pdfverified 2026-09-07	not provided
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	<= 5/15/2026 (initial prenatal visit)	Any	Any	Initial prenatal (confirmation of pregnancy)	All	Global obstetric codes may still be used	Global OB codes	not provided	not provided	not provided	not provided	not provided	recommends (may)	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“Until May 15, 2026 - Global obstetric codes still may be used”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	5/15/2026 - 7/14/2026 (initial prenatal visit)	Any	Any	Initial prenatal	Antepartum + Delivery	59426 + delivery-only code	59426 + delivery only	not provided	not provided	not provided	Global OB codes	not provided	recommends	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“May 15, 2026 - July 14, 2026 - Use CPT code 59426 + delivery only”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	7/15/2026 - 9/1/2026 (initial prenatal visit)	Any	Any	Initial prenatal	Antepartum + Delivery	59425 + delivery-only code	59425 + delivery only	not provided	not provided	not provided	Global OB codes	not provided	recommends	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“July 15, 2026 - September 1, 2026 - Use CPT code 59425 + delivery”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	>= 9/1/2026 (initial prenatal visit)	Any	Any	Initial prenatal	All	Further guidance to be provided	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	Recommended 2026 guidelines ahead of 1/1/2027	pending	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“Arkansas Blue Cross will provide further guidance on recommended billing practices for initial prenatal visits for confirmation of pregnancy that occur on or after September 1, 2026.”
No plan in directory 0/3 plans published	TennCare (Tennessee Medicaid)	TennCare Episodes of Care - Perinatal episode	Any	Any	Any	Any	All	No billing/workflow change - perinatal episode performance pause for 2027 only (not a coding instruction)	not provided	not provided	not provided	not provided	not provided	not provided	n/a	Not provided (source is not a billing instruction)	Memo 2026-08-21	not a billing instruction	contracted MCO's provider relations team	not provided	D12https://www.tn.gov/content/dam/tn/tenncare/documents2/TemporaryPausePerinatalPerformance.pdfverified 2026-09-07	“Are providers required to change any workflows? No. Clinical workflows and patient care processes remain the same.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	< 9/1/2026 (first prenatal visit after confirmation)	Any	4-6 / 7+	Routine prenatal	Antepartum	Continue 59425 (4-6 visits) / 59426 (7+ visits)	59425, 59426	not provided	not provided	not provided	not provided	not provided	should	Provided	All Provider Bulletin 419, August 2026; guidance effective 9/1/2026	operational	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“For services rendered to patients whose first prenatal visit following confirmation of pregnancy occurred before September 1, 2026, providers should continue to bill using CPT code 59425 (Antepartum care only; 4- 6 visits) and CPT code 59426 (Antepartum care only; 7 or more visits), when applicable.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	>= 9/1/2026 (first prenatal visit after confirmation)	Any	Any	Routine prenatal	Antepartum	May report setting-appropriate E/M + TH (office 99202-99205/99211-99215; hospital 99221-99236; telemedicine 98000-98015)	99202-99215, 99221-99236, 98000-98015	TH	not provided	not provided	not provided	not provided	may	Provided	Effective 9/1/2026	operational (permissive)	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“For services rendered to patients whose first prenatal visit following confirmation of pregnancy occurred on or after September 1, 2026, providers may report services using the appropriate evaluation and management (E/M) code with modifier TH to indicate the visit is related to prenatal care.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	>= 1/1/2027 (DOS)	Any	Any	Any	All	Additional 2027 guidance planned	not provided	not provided	not provided	not provided	AMA-deleted global codes (59050 59400 59409 59410 59425 59426 59430 59510 59514 59415 59525 59610 59612 59614 59618 59620 59622)	not provided	not provided	Not provided	not provided	pending	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“MassHealth plans to provide additional billing guidance in 2027 for the AMA 2027 Maternity Services Coding Structure.”
Some plans in directory 1/2 plans published	Blue Cross and Blue Shield of Texas	Professional (RP044)	Any	Any	Any	Any	All	Current global OB package rules (RP044); no 2027 instruction	Global OB package per RP044	not provided	not provided	Encouraged, not required (quality measurement only; no effect on reimbursement): 0500F or 0501F with the initial visit; 0503F with the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	Approved 5/15/2026, effective 5/22/2026	current policy; no CPT 2027 content	not provided	not provided	D14https://www.bcbstx.com/docs/provider/tx/standards/clinical-pay-coding/2026/rp044-5-22-2026.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	1-3 visits	Antepartum only (split care)	Antepartum	E&M codes	E&M	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	Reference guide (undated)	current policy; no CPT 2027 content	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 1-3 visits Use E&M Codes”
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	4-6 visits	Antepartum only	Antepartum	59425	59425	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 4-6 visits 59425”
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	7+ visits	Antepartum only	Antepartum	59426	59426	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 7 or more visits 59426”
Some plans in directory 2/6 plans published	CareFirst BlueCross BlueShield	per Provider Manual Ch. 9	Any	Any	Any	Any	All	Global obstetrical package per medical policy 4.01.006A; no 2027 instruction	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided (reference only)	not provided	current policy; no CPT 2027 content	gender.services@carefirst.com is the only contact in the chapter (unrelated program)	not provided	D21https://provider.carefirst.com/carefirst-resources/provider/pdf/provider-manual-chapter-9-policies-procedures.pdfverified 2026-09-07	not provided
Some plans in directory 8/10 plans published	UnitedHealthcare	All UnitedHealthcare Commercial benefit plans (and Individual Exchange)	Any	Any	Any	Any	All	Current global OB package rules (2026R0064A); no 2027 instruction	Global OB package	not provided	not provided	not provided	not provided	not provided	not provided	Provided (current policy only)	2026R0064A	current policy; no CPT 2027 content	not provided	not provided	D27https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Obstetrical-Policy.pdfverified 2026-09-07	not provided
Some plans in directory 1/3 plans published	Medi-Cal (California DHCS)	Medi-Cal fee-for-service provider manual	Any	Any	Any	Any	All	Global billing 59400/59510/59610/59618 with pregnancy diagnosis; no 2027 instruction	59400, 59510, 59610, 59618	not provided	Pregnancy diagnosis required	not provided	not provided	not provided	not provided	Provided (current policy only)	Manual page updated January 2026	current policy; no CPT 2027 content	not provided	not provided	D31https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/F01FC605-49CD-4474-827D-CEEEB7EF02C3/pregglo.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULOverified 2026-09-07	not provided
In directory 1/1 plan published	TRICARE (DHA)	TRICARE (Reimbursement Manual TR15 Ch.1 Sec.18)	Any	Any	Any	Any	All	All-inclusive global maternity fee (59400/59510) when one provider furnishes all segments; separate billing when care is split	59400, 59510 or component codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy; no CPT 2027 content	not provided	not provided	D36https://manuals.dha.mil/View-Publication/TR15/FileName/C1S18?referenceDate=2024-05-07verified 2026-09-07	not provided
Some plans in directory 17/18 plans published	Centene (corporate template CC.PP.016)	Adopting health plans, each on its own effective date ('Health Plan means a health plan that has adopted this payment policy')	Any	Any	Any	Any	All	Global maternity package reporting and prepayment code review; no 2027 instruction; adoption by any specific plan not verified	Global maternity package	not provided	not provided	not provided	not provided	not provided	not provided	Provided (template; plan adoption not provided)	effective as of the date determined by Health Plan	current policy template; no CPT 2027 content	not provided	not provided	D01https://www.centene.com/content/dam/centene/policies/payment-policies/CC.PP.016.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	not stated	>= 9/1/2026 (DOS)	Any	Any	First prenatal visit after confirmation and subsequent antepartum visits	Antepartum	Must bill E/M + TH + Z34.XX or O00-O9A	Appropriate E/M	TH	Z34.XX or O00-O9A	not provided	59425/59426 for these DOS (implied)	not provided	must	Provided	August 2026 notification (updated 7/30/2026), effective 09/01/2026	operational	not provided	not provided	D15https://www.bluecrossvt.org/documents/august-2026-changes-maternity-care-services-coding-and-billing-notice-publicationverified 2026-09-07	“beginning on and for dates of service on or after September 1, 2026, claims for the first prenatal visit after confirmation of pregnancy and subsequent antepartum visits must be billed with: An appropriate E/M code appended with modifier -TH to differentiate the visits as maternity care, and An appropriate ICD-10-CM code Z34.XX to verify the gestation of the pregnancy or with an appropriate pregnancy diagnosis code O00-O9A.”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	not stated	<= 8/31/2026 (DOS)	Any	4-6 / 7+ or E/M	Prenatal	Antepartum	Appropriate E/M or 59425 (4-6) / 59426 (7+)	E/M or 59425/59426	not provided	not provided	not provided	not provided	not provided	should	Provided	August 2026 notification	operational	not provided	not provided	D15https://www.bluecrossvt.org/documents/august-2026-changes-maternity-care-services-coding-and-billing-notice-publicationverified 2026-09-07	“Claims for prenatal care for dates of services on or before August 31, 2026, should be billed with the appropriate E/M code or the current antepartum codes 59425 (4-6 visits) or 59426 (7 or more visits).”
Some plans in directory 1/2 plans published	Blue Cross NC	not stated	>= 1/1/2027 (services performed)	Any	Any	Any	All	Aligning with AMA; providers 'will need to make changes ... beginning mid-May 2026'; no billing instruction; additional guidance to be shared	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	News 2026-05-26	awareness only	not provided	'coming months' (from 2026-04); billing changes begin mid-May 2026	D17https://www.bcbsnc.com/providers/provider-news/2026/changes-to-billing-for-global-maternity-services-effective-1-1-27verified 2026-09-07	“providers will need to make changes ... beginning mid-May 2026 to support accurate reimbursement of services performed on or after January 1, 2027”
In directory 1/1 plan published	Community First Health Plans (TX)	Medicaid/CHIP site ('advance awareness communication')	>= 1/1/2027	Any	Any	Any	All	Lists 2027 CPT changes (59080-59083, 59431/59432/59502/59503); implementation and reimbursement details to follow	2027 codes listed for awareness only	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	Notice 2026-08-03	awareness only	Provider Relations ProviderRelations@cfhp.com, 210-358-6030	No date - 'as more information becomes available'	D22https://medicaid.communityfirsthealthplans.com/2026/08/03/important-notice-2027-maternity-care-coding-updates/verified 2026-09-07	“advance awareness communication”
Some plans in directory 13/22 plans published	Highmark (Highmark BS CPA/SEPA, BCBS DE, BS NENY, BCBS WNY, BCBS WPA/NEPA, BCBS WV)	Professional and facility providers, all listed regions	Any	Any	Any	Any	All	Highmark 'is conducting a comprehensive review'; will formally notify of changes; no billing instruction	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	News 2026-07-01	awareness only	not provided	No date - 'will formally notify you of any changes'	D23https://providers.highmark.com/communications-hub/news-and-updates/maternity-billing-changes-for-2027.htmlverified 2026-09-07	“is conducting a comprehensive review”
In directory 2/2 plans published	Geisinger Health Plan	All GHP plan offerings ('apply consistently across all GHP plan offerings')	Any (until formally notified)	Any	Any	Any	All	Continue billing maternity services as you do today until formally notified; grace periods promised (no dates)	Current codes	not provided	not provided	not provided	not provided	not provided	continue	Provided (hold instruction)	Update 2026-05-15	awareness / hold	Claims: 844-GHP-PROV (844-447-7768)	No date - operational details, billing guidance, educational resources 'as implementation planning continues'	D24https://www.geisinger.org/health-plan/providers/updates/search-updates/2026/05/27/16/01/maternity-cpt-coding-modernizationverified 2026-09-07	“Until you are formally notified by GHP, continue billing maternity services as you do today”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Antepartum	Individual codes per date of service; global/prenatal-bundle codes rejected (code 272)	Prenatal: 99202-99205, 99211-99215, 99242-99245, 99457, 99458, 99483	not provided	not provided	not provided	59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622, 59425, 59426, H1005	not provided	must	Provided	Revised July 2026; DOS after March 1, 2026	operational (current policy; no CPT 2027 content)	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Providers must bill for maternity services claims using individual service codes rather than global maternity codes that bundle multiple services.”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Delivery	Delivery-only codes	59409, 59620, 59612, 59514	not provided	not provided	not provided	Global delivery+care codes	not provided	must	Provided	Revised July 2026	operational	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Delivery 59409 Vaginal delivery only ... 59620 ... 59612 ... 59514 Cesarean delivery only without postpartum care.”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Postpartum	Postpartum individual codes	57170, 58300, 59430, 99202-99205, 99211-99215	not provided	not provided	not provided	Postpartum bundled codes	not provided	must	Provided	Revised July 2026	operational	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Postpartum Care CPT: 57170, 58300, 59430, 99202-99205, 99211-99215”
In directory 57/57 plans published	CMS Medicare (Physician Fee Schedule) - all Part B MACs	Medicare Part B	>= 1/1/2027 (CY 2027)	Any	Any	Any	All	PROPOSED only: value new CPT maternity codes AND seek comment on 15 G-codes mirroring the global structure 'in lieu of adoption of the new CPT codes' - not final; no billing instruction yet	not provided	not provided	not provided	not provided	not provided	not provided	proposed	Not provided (proposed rule)	Federal Register 2026-07-16 (proposed)	proposed rule	MedicarePhysicianFeeSchedule@cms.hhs.gov; claims questions to the Medicare Administrative Contractor	Comment period ends 2026-09-14; CY 2027 PFS final rule (CMS-1848-P) to follow	D33https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-otherverified 2026-09-07	“in lieu of adoption of the new CPT codes for purposes of Medicare payment”
No plan in directory 0/2 plans published	BlueCross BlueShield of Tennessee	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Cited July 2026 BlueAlert could not be retrieved - rolling URL serves the September 2026 issue with no maternity article	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Provider Network Manager (generic BlueAlert footer)	not provided	D20https://content.bcbst.com/api/public/content/prov-bluealert.pdfverified 2026-09-07	not provided
In directory 9/9 plans published	Humana	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Claims payment policies index contains no maternity/obstetric policy	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	not provided	not provided	D28https://provider.humana.com/coverage-claims/claims-payment-policiesverified 2026-09-07	not provided
Some plans in directory 1/2 plans published	Kaiser Permanente Northern California	HMO provider manual	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Manual text contains no maternity/obstetric/global billing section	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Medical Services Contracting (925) 924-5050	not provided	D30https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/ever/hmo-provider-manual-en.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Oscar Health	Individual & Family / Small Group (member benefits page)	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Member coverage page, not a provider billing policy	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Member Care Team 1-855-672-2755 (member line, not provider)	not provided	D35https://www.hioscar.com/maternityverified 2026-09-07	not provided
In directory 1/1 plan published	UMR	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Generic claim-submission page; no maternity content	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	not provided	not provided	D37https://www.umr.com/provider/Claimsubmissionsverified 2026-09-07	not provided
In directory 1/1 plan published	Capital Blue Cross	See payer-policy scope and source	before 9/1/2026 (first prenatal visit after confirmation)	Any	Any	Routine prenatal	Antepartum	Use current bundled antepartum coding	59425 (4–6 visits); 59426 (7+ visits)	not provided	not provided	not provided	not provided	not provided	will	Provided	Policy effective 9/1/2026; bulletin published 7/1/2026	current global-based billing before transition	not provided	not provided	D46https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-informationverified 2026-09-08	“Prior to September 1, 2026 ... 59425 ... 59426.”
In directory 1/1 plan published	Capital Blue Cross	See payer-policy scope and source	>= 9/1/2026 (first prenatal visit after confirmation)	Any	Any	Routine prenatal	Antepartum	E/M code + TH + appropriate ICD-10-CM including gestational week	Appropriate E/M	TH	Appropriate ICD-10-CM, including Z3A.XX	not provided	59425/59426 solely for this newly starting visit-based cohort	not provided	require	Provided	Policy effective 9/1/2026; bulletin published 7/1/2026	operational transition guidance	not provided	not provided	D46https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-informationverified 2026-09-08	“On or after September 1, 2026 ... require the use of evaluation and management (E/M) codes with ... TH ... [and] ... Z3A.XX.”
In directory 1/1 plan published	Capital Blue Cross	See payer-policy scope and source	>= 1/1/2027 (DOS)	Any	Any	Any	Labor management / Delivery / Postpartum	Bill component maternity service under FP-01.011	59080–59083, 59030, 59051, 59431–59504, applicable E/M as described	not provided	not provided	not provided	Global obstetric package	not provided	will	Provided	Component transition effective 1/1/2027	operational 2027 guidance	not provided	not provided	D46https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-informationverified 2026-09-08	“Reimbursement Policy FP-01.011 also addresses ... services transitioning from global-based billing to visit/service-based billing effective January 1, 2027.”
In directory 1/1 plan published	Capital Blue Cross	See payer-policy scope and source	>= 11/1/2026 (DOS)	Any	Any	Any	All maternity-related procedures	Append TH to all maternity-related procedure codes	not provided	TH	not provided	not provided	not provided	not provided	must	Provided	Policy update effective 11/1/2026; bulletin published 9/1/2026	policy amendment	not provided	not provided	D46https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-09-001-updates-new-informationverified 2026-09-08	“Providers must append HCPCS modifier TH to all maternity-related procedure codes, not just evaluation and management (E/M) procedure codes.”
In directory 2/2 plans published	Premera Blue Cross	See payer-policy scope and source	5/15/2026 - 7/14/2026 (first antepartum visit)	12/1/2026 - 1/31/2027 (EDD)	7+ visits	Routine prenatal	Antepartum / Delivery	Bill 59426, then the delivery-only code applicable to the actual delivery date	59426 + applicable delivery-only code	not provided	not provided	not provided	Global maternity package	not provided	use	Provided	Tip sheet published 7/27/2026	cross-year transition guidance	not provided	not provided	D47https://www.premera.com/documents/072079.pdfverified 2026-09-08	“First antepartum visit between May 15 and July 14 ... bill 59426 and the delivery-only code ... based on date of delivery.”
In directory 2/2 plans published	Premera Blue Cross	See payer-policy scope and source	7/15/2026 - 8/31/2026 (first antepartum visit)	1/1/2027 - 4/30/2027 (EDD)	4-6 visits	Routine prenatal	Antepartum / Delivery	Bill 59425, then the 2027 delivery-only code	59425 + 2027 delivery-only code	not provided	not provided	not provided	Global maternity package	not provided	use	Provided	Tip sheet published 7/27/2026	cross-year transition guidance	not provided	not provided	D47https://www.premera.com/documents/072079.pdfverified 2026-09-08	“First antepartum visit between July 15 and September 1 ... bill 59425 and the 2027 delivery-only code.”
In directory 2/2 plans published	Premera Blue Cross	See payer-policy scope and source	>= 9/1/2026 (first antepartum visit)	> 4/30/2027 (EDD)	Any	Routine prenatal	Antepartum	Bill E/M; 59425 may remain available when 4+ visits occur before 2027	Appropriate E/M; 59425 if stated visit threshold is met	TH	not provided	not provided	Global maternity package	not provided	use	Provided	Tip sheet published 7/27/2026	cross-year transition guidance	not provided	not provided	D47https://www.premera.com/documents/072079.pdfverified 2026-09-08	“For first antepartum visits on or after September 1 ... use E/M codes; 59425 may still be used if four or more visits occur before January 1, 2027.”
In directory 2/2 plans published	Premera Blue Cross	See payer-policy scope and source	>= 1/1/2027 (DOS)	Any	4-6 visits	Routine prenatal	Antepartum	Use 59425 for 4–6 2026 antepartum visits; otherwise follow the service-level 2027 instruction	59425 or appropriate 2027 service-level code	not provided	not provided	not provided	Deleted global maternity codes	not provided	use	Provided	Updated maternity coding starts 1/1/2027	2027 transition guidance	not provided	not provided	D47https://www.premera.com/documents/072079.pdfverified 2026-09-08	“At midnight January 1 ... four to six visits: 59425 ... 2027 delivery-only/labor codes; postpartum E/M + TH.”
In directory 2/2 plans published	Florida Blue / Truli for Health	See payer-policy scope and source	1/1/2026 - 12/31/2026 (DOS)	>= 1/1/2027 (delivery)	<= 3 visits	Routine prenatal	Antepartum	Bill individual E/M	Appropriate E/M	TH not required; encouraged	not provided	not provided	Global obstetric bundle	not provided	use	Provided	Notice dated 8/2026; 2027 framework effective 1/1/2027	cross-year transition guidance	not provided	not provided	D48https://files.guidewell.com/asset/9719a865-d09f-45f8-b0ef-5519b03ee1f3/providers-news-2026-billing-coding-maternity-cpt-code-changes-08-2026.pdfverified 2026-09-08	“For 2027 deliveries ... one to three antepartum visits in 2026: bill E/M.”
In directory 2/2 plans published	Florida Blue / Truli for Health	See payer-policy scope and source	1/1/2026 - 12/31/2026 (DOS)	>= 1/1/2027 (delivery)	4-6 visits	Routine prenatal	Antepartum	Bill 59425	59425	TH not required; encouraged	not provided	not provided	Global obstetric bundle	not provided	use	Provided	Notice dated 8/2026; 2027 framework effective 1/1/2027	cross-year transition guidance	not provided	not provided	D48https://files.guidewell.com/asset/9719a865-d09f-45f8-b0ef-5519b03ee1f3/providers-news-2026-billing-coding-maternity-cpt-code-changes-08-2026.pdfverified 2026-09-08	“For 2027 deliveries ... four to six antepartum visits in 2026: bill 59425.”
In directory 2/2 plans published	Florida Blue / Truli for Health	See payer-policy scope and source	1/1/2026 - 12/31/2026 (DOS)	>= 1/1/2027 (delivery)	7+ visits	Routine prenatal	Antepartum	Bill 59426	59426	TH not required; encouraged	not provided	not provided	Global obstetric bundle	not provided	use	Provided	Notice dated 8/2026; 2027 framework effective 1/1/2027	cross-year transition guidance	not provided	not provided	D48https://files.guidewell.com/asset/9719a865-d09f-45f8-b0ef-5519b03ee1f3/providers-news-2026-billing-coding-maternity-cpt-code-changes-08-2026.pdfverified 2026-09-08	“For 2027 deliveries ... seven or more antepartum visits in 2026: bill 59426.”
In directory 2/2 plans published	Florida Blue / Truli for Health	See payer-policy scope and source	>= 1/1/2027 (DOS)	Any	Any	Any	Antepartum / Labor management / Delivery / Postpartum	Bill maternity services separately under the new CPT framework	Appropriate E/M and applicable 2027 CPT codes	TH not required for routine prenatal E/M; encouraged	not provided	not provided	Global obstetric bundle	not provided	will	Provided	Effective 1/1/2027	announced; fuller policy forthcoming	not provided	Additional policy forthcoming	D48https://files.guidewell.com/asset/9719a865-d09f-45f8-b0ef-5519b03ee1f3/providers-news-2026-billing-coding-maternity-cpt-code-changes-08-2026.pdfverified 2026-09-08	“Florida Blue and Truli for Health are eliminating global obstetric bundles and transitioning to itemized billing for maternity care.”
In directory 1/1 plan published	SoonerCare	See payer-policy scope and source	>= 9/1/2026 (new prenatal patient)	Any	<= 3 visits	Routine prenatal	Antepartum	Bill individual E/M + TH	Appropriate E/M	TH	Pregnancy diagnosis	not provided	59425/59426 for 1–3 visits	not provided	use	Provided	Transition effective 9/1/2026	state Medicaid transition guidance	not provided	not provided	D49https://oklahoma.gov/ohca/providers/updates/global-messages/2026-global-messages.htmlverified 2026-09-08	“One to three visits: bill individual E/M services ... TH modifier is requested to avoid denials.”
In directory 1/1 plan published	SoonerCare	See payer-policy scope and source	>= 9/1/2026 (new prenatal patient)	Any	4-6 visits	Routine prenatal	Antepartum	Bill 59425 for the initial block, then E/M for ongoing visits	59425 + appropriate E/M	TH on E/M	Pregnancy diagnosis	not provided	59426 before seven visits	not provided	use	Provided	Transition effective 9/1/2026	state Medicaid transition guidance	not provided	not provided	D49https://oklahoma.gov/ohca/providers/updates/global-messages/2026-global-messages.htmlverified 2026-09-08	“Four to six visits: bill 59425 for the initial block, then E/M for ongoing visits.”
In directory 1/1 plan published	SoonerCare	See payer-policy scope and source	>= 9/1/2026 (new prenatal patient)	Any	7+ visits	Routine prenatal	Antepartum	Bill 59426; do not bill 59426 then E/M before year-end	59426	not provided	not provided	not provided	E/M after 59426 before 12/31/2026	not provided	do not	Provided	Transition effective 9/1/2026	state Medicaid transition guidance	not provided	not provided	D49https://oklahoma.gov/ohca/providers/updates/global-messages/2026-global-messages.htmlverified 2026-09-08	“Seven or more visits: bill 59426. Do not bill 59426 then E/M before 12/31/26.”
In directory 1/1 plan published	SoonerCare	See payer-policy scope and source	1/1/2026 - 12/31/2026 (prenatal DOS)	>= 1/1/2027 (delivery)	Any	Any	Delivery	Do not bill bundled delivery codes	Appropriate separate delivery service	not provided	not provided	not provided	Bundled delivery codes	not provided	cannot	Provided	2027 delivery transition	state Medicaid transition guidance	not provided	not provided	D49https://oklahoma.gov/ohca/providers/updates/global-messages/2026-global-messages.htmlverified 2026-09-08	“Prenatal in 2026, delivery in 2027 cannot use bundled delivery codes.”
In directory 1/1 plan published	Priority Health	See payer-policy scope and source	>= 6/1/2026 (prenatal-care start)	Any	Any	Routine prenatal	Antepartum	Bill E/M + required TH + correct pregnancy diagnosis	Appropriate E/M	TH	Correct pregnancy diagnosis	not provided	Global maternity codes	not provided	must	Provided	Transition effective 6/1/2026	operational transition guidance	not provided	not provided	D50https://priorityhealth.stylelabs.cloud/api/public/content/Maternity_and_prenatal_care_billing_policy_downloadOriginal?v=89695898verified 2026-09-08	“Patients who begin prenatal care on or after June 1, 2026, will no longer be billed using global maternity care codes. Instead, all visits must be billed using appropriate E/M codes, required TH modifier, correct pregnancy diagnosis.”
In directory 1/1 plan published	Blue Cross Blue Shield of Wyoming	See payer-policy scope and source	Any	>= 1/1/2027 (expected delivery)	Any	Any	Antepartum / Labor / Delivery / Postpartum	Bill applicable services separately	Appropriate separate CPT codes	not provided	not provided	not provided	Global maternity codes	not provided	do not	Provided	Notice published 6/19/2026; applies to expected deliveries on/after 1/1/2027	date-only operational instruction	not provided	not provided	D51https://www.bcbswy.com/provider_updates/updated-provider-manual-now-available/verified 2026-09-08	“Deliveries expected on or after 1/1/27: do not bill global; bill separate applicable CPT for antepartum, labor, delivery, postpartum.”
In directory 1/1 plan published	Sentara Health Plans	See payer-policy scope and source	Any	>= 1/1/2027 (delivery)	Any	Any	Antepartum	Bill 59425 or 59426; source does not state the selection threshold	59425 or 59426	not provided	not provided	not provided	not provided	not provided	should	Provided	Notice published 9/3/2026; effective immediately	interim instruction; details pending	not provided	Additional Sentara resources forthcoming	D52https://shc-p-001.sitecorecontenthub.cloud/api/public/content/4be7df652ef8413a905e1a91e2d3f639?v=2fb7790bverified 2026-09-08	“Effective immediately, providers should bill 59425 and 59426 for maternity services for Sentara members pregnant but delivering after January 1, 2027.”
In directory 1/1 plan published	Security Health Plan	See payer-policy scope and source	>= 1/1/2027 (DOS)	Any	Any	Any	All	Use itemized maternity billing; coding details not published	not provided	not provided	not provided	not provided	Global maternity codes	not provided	will	Provided	Newsletter published July 2026; effective 1/1/2027	awareness notice only	not provided	not provided	D53https://myemail.constantcontact.com/July-2026-Provider-News-.html?aid=azd6cYnDVio&soid=1116859727355verified 2026-09-08	“Billing for maternity care services will transition from the use of global maternity care codes to an itemized billing structure effective Jan. 1, 2027.”
In directory 1/1 plan published	WPS Health Plan	See payer-policy scope and source	>= 9/1/2026 (DOS)	Any	Any	Prenatal / antepartum	Antepartum	Report the appropriate E/M code + TH	Appropriate E/M	TH	not provided	not provided	not provided	not provided	requesting	Provided	Early transition 9/1/2026; 2027 coding takes effect 1/1/2027	early transition request	not provided	not provided	D54https://www.wpshealth.com/providers/verified 2026-09-08	“WPS is requesting that providers begin reporting prenatal/antepartum visits using the appropriate E/M codes for dates of service on or after September 1, 2026. Modifier TH ... should be appended.”
In directory 1/1 plan published	WPS Health Plan	See payer-policy scope and source	>= 1/1/2027 (DOS)	Any	Any	Any	Antepartum / Labor management / Delivery / Postpartum	Use per-encounter maternity reporting	Appropriate E/M and applicable component codes	not provided	not provided	not provided	Current global maternity care codes	not provided	will	Provided	2027 coding takes effect 1/1/2027	framework notice; detailed claim rules absent	not provided	not provided	D54https://www.wpshealth.com/providers/verified 2026-09-08	“WPS is preparing for significant changes to maternity care that will take effect January 1, 2027 ... replace the current global maternity care codes with per-encounter reporting.”
In directory 1/1 plan published	Horizon Blue Cross Blue Shield of New Jersey	See payer-policy scope and source	>= 9/1/2026 (DOS; after initial pregnancy confirmation)	Any	Any	Routine prenatal	Antepartum	Horizon encourages existing E/M + -TH + appropriate maternity diagnosis	Existing appropriate E/M	-TH	Appropriate maternity diagnosis	not provided	not provided	not provided	encourages	Provided	Notice published and updated 8/25/2026; applies to DOS on/after 9/1/2026	payer practice guidance, not a stated billing mandate	Assigned Provider Account Specialist	not provided	D55https://www.horizonblue.com/providers/news/news-legal-notices/preparing-ama-s-transition-component-based-maternity-billingverified 2026-09-08	“Horizon encourages providers to submit prenatal visit claims using existing evaluation and management (E/M) codes with modifier -TH and the appropriate maternity diagnosis code.”
In directory 1/1 plan published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 9/1/2026	>= 1/1/2027 ('expected to deliver in 2027')	<= 3 prenatal visits before 1/1/2027	Routine (preventive) prenatal	Antepartum	E/M code + modifier TH + pregnancy diagnosis code(s)	Applicable E/M code	TH	Pregnancy diagnosis code(s) linked to the E/M	not provided	Global / antepartum bundle for these visits	$0 (routine prenatal/postpartum E/M are preventive, no member cost-share)	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational transition guidance; 2027 claims-processing details still to come	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-10-06	“For patients expected to deliver in 2027, preventive prenatal visits on or after September 1, 2026 should be billed with the applicable E/M code, modifier TH and pregnancy diagnosis code(s) when three or fewer visits are provided before January 1, 2027.”
In directory 1/1 plan published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 9/1/2026	>= 1/1/2027	>= 4 prenatal visits in 2026	Routine prenatal	Antepartum	Current antepartum coding guidelines (global/antepartum bundle)	Current antepartum codes (59425/59426 by count) - codes not named in article	not provided	not provided	not provided	E/M+TH for these visits (not stated; inferred from 'follow current antepartum coding')	$0	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational transition guidance	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-10-06	“Once four prenatal visits have occurred in 2026, billing should follow the current antepartum coding guidelines.”
In directory 1/1 plan published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 1/1/2027 (DOS)	Any	Any	Any	All	Bill maternity services individually under the new CPT framework (antepartum, labor management, delivery, postpartum); operational details forthcoming	New 2027 CPT codes (not enumerated)	not provided	not provided	not provided	Deleted global codes	$0 for routine prenatal/postpartum E/M	will (framework final)	Provided (framework only; codes/claims rules not provided)	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	announced; implementation details pending	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-10-06	“The overall coding framework is final, but implementation details, such as those related to operations and claims processing, are still to come.”
In directory 1/1 plan published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	Any	Any	Any	Non-routine (medical condition / complication)	Antepartum / Postpartum	Bill by the medical reason for the encounter, WITHOUT modifier TH	E/M by medical reason	none (do not use TH)	Diagnosis for the medical condition	not provided	TH-appended E/M	Subject to member cost-share	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-10-06	“Non-routine prenatal and postpartum E&M office visits shouldn't be submitted with modifier TH and are subject to member cost-share.”
In directory 1/1 plan published	MaineCare (Maine DHHS OMS)	Medicaid	before 9/1/2026 (act 'no later than prior to September 1, 2026')	Used as the trigger: bill by EDD and anticipated remaining antepartum visits	Per AMA Antepartum Transition Reporting guidance	Routine prenatal / postpartum	Antepartum / Postpartum	Move from global/bundled codes to E/M based on EDD and anticipated remaining visits; TH on ALL maternity E/M; each visit documented independently; maternity dx codes on all claims	E/M codes	TH on all maternity care E/M	Maternity-related diagnosis codes on all claims	not provided	Global / bundled service codes (per transition)	not provided	directing (must)	Provided (visit-count thresholds delegated to AMA guidance)	Bulletin: effective September 1, 2026	operational	Provider Relations Specialist (no number in notice); Maine DHHS (207) 287-3707	not provided	D09https://www.maine.gov/dhhs/oms/providers/provider-bulletins/addition-th-modifier-support-national-maternity-care-coding-and-reimbursement-changesverified 2026-10-06	“Adjust maternity care visit billing from global or bundled service codes to Evaluation and Management (E/M) service codes based on each member's estimated due date and the anticipated number of visits for the remainder of their antepartum period in accordance with AMA Antepartum Transition Reporting guidance”
In directory 1/1 plan published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	<= 12/31/2026 (DOS)	Any	Any	Any	All	Current global codes and current modifier requirements remain; no early itemized transition (HCA will NOT follow ACOG September 2026 approach); no proration	Current global OB codes; 0500F first prenatal visit	Current modifier requirements through 12/31/2026	not provided	not provided	Itemized E/M in lieu of global before 1/1/2027 (not adopted)	0500F pays $0 (billed at $0.01)	will not (no early transition)	Provided	FAQ June 2026	operational (hold)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-10-06	“HCA does not plan to: Follow American College of Obstetricians and Gynecologists' (ACOG) recommendation for September 2026 implementation to itemized billing. Prorate payments for global OB codes.”
In directory 1/1 plan published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	>= 1/1/2027 (DOS)	Any	Any	First prenatal visit	Antepartum	Bill appropriate E/M (reimbursable) + 0500F (pays zero); deleted global codes removed from billing guides; cross-year and modifier guidance to be published	E/M + 0500F	pending ('HCA will provide updated modifier guidance')	Pregnancy-related primary diagnosis identifies pregnancy E/M	Required: 0500F on the first prenatal visit ('Providers must continue submitting CPT code 0500F to identify the first prenatal visit'; HEDIS Timeliness of Prenatal Care; pays zero)	Deleted global obstetrics codes	0500F pays zero	should	Provided (partial; cross-year/modifier guidance pending)	Effective 1/1/2027	operational (partial)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-10-06	“Effective January 1, 2027: The first prenatal visit should be billed with the appropriate Evaluation and Management (E/M) code and CPT 0500F. The E/M code will be reimbursable. CPT 0500F will continue to pay zero.”
In directory 1/1 plan published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	Care spans 2026 -> 2027	>= 1/1/2027	Any	Any	All	Guidance to be published in Pregnancy-related services and Planned home births billing guides	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	pending	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-10-06	“HCA will publish guidance for clients whose pregnancy care spans 2026 and 2027.”
In directory 1/1 plan published	UnitedHealthcare	Commercial. Not Dental, Vision, Community Plan, Medicare Advantage, or AARP supplemental.	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	If CMS finalizes the proposed 2027 maternity HCPCS G-codes, report maternity services with those G-codes	applicable CMS-designated HCPCS G-codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final; contingent on the final CMS rule	not provided	not provided	D64https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“If CMS finalizes its proposed 2027 maternity HCPCS G-codes as originally proposed, including being effective January 1, 2027, providers should report maternity services using the applicable CMS-designated HCPCS G-codes.”
In directory 1/1 plan published	UnitedHealthcare	Commercial	>= 1/1/2027 ('effective Jan. 1, 2027')	Any	Any	Any	All	If the CMS proposal is not finalized, CPT maternity care leaves global obstetric reporting for phase-based reporting	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D64https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“If the CMS proposal is not finalized as proposed, effective Jan. 1, 2027, CPT® maternity care services will transition from global obstetric reporting to phase-based reporting, including antepartum, labor management, delivery, and postpartum care.”
In directory 1/1 plan published	UnitedHealthcare	Commercial	<= 12/31/2026 ('on or before Dec. 31, 2026')	Any	Any	Any	All	Report services rendered on or before December 31, 2026 under CPT 2026, including 59425, 59426, or an E/M code	59425, 59426, or applicable E/M	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D64https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“Services rendered on or before Dec. 31, 2026, should be reported in accordance with CPT® 2026 guidelines, including CPT® 59425, 59426, or applicable E/M services.”
In directory 1/1 plan published	UnitedHealthcare	Commercial	>= 1/1/2027 ('on or after Jan. 1, 2027')	Any	Any	Any	All	If the CMS proposal is not finalized, report services rendered on or after January 1, 2027 with the appropriate E/M code	appropriate E/M code	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D64https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“Services rendered on or after Jan. 1, 2027, should be reported using the appropriate E/M code.”
In directory 1/1 plan published	UnitedHealthcare	Commercial	not provided	Any	Any	Any	Antepartum / Postpartum	Report antepartum and postpartum services with the appropriate E/M code, modifier TH, and the obstetrical primary diagnosis	appropriate E/M code	TH	appropriate obstetrical primary diagnosis	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D64https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“Antepartum and Postpartum services should be reported with the appropriate E/M code, modifier TH, and the appropriate obstetrical primary diagnosis.”
In directory 1/1 plan published	AARP UnitedHealthCare Insurance Company	Supplemental. Not the commercial UnitedHealthcare record.	Any	Any	Any	Any	All	Do not apply the October 2026 UnitedHealthcare commercial obstetric bulletin to this supplemental row	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance; exclusion	not provided	not provided	D83https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-October-2026.pdfverified 2026-10-06	“UnitedHealthcare Commercial Reimbursement Policy Update Bulletin: October 2026”
In directory 1/1 plan published	5Star Life	Healthcare indemnity. Not an obstetric billing policy.	Any	Any	Any	Any	All	Supplemental medical does not replace health insurance. No obstetric code rule is stated.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	awareness_only	not provided	not provided	D65https://www.5starlifeinsurance.com/products/healthcare-indemnity/verified 2026-10-06	“Supplemental Medical does NOT replace health insurance.”
In directory 1/1 plan published	5Star Life	Healthcare indemnity. Not an obstetric billing policy.	Any	Any	Any	Any	All	Supplemental medical does not replace health insurance. No obstetric code rule is stated.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	awareness_only	not provided	not provided	D65https://www.5starlifeinsurance.com/products/healthcare-indemnity/verified 2026-10-06	“Supplemental Medical does NOT replace health insurance.”
In directory 1/1 plan published	6 Degrees Health	Continuity-of-care page. Not an obstetric code policy.	Any	Any	Any	Any	All	The page refers to patients who are pregnant and undergoing a course of treatment for the pregnancy. It states no obstetric code.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	awareness_only	not provided	not provided	D66https://www.6degreeshealth.com/continuity-of-care-requirements-no-surprises-act/verified 2026-10-06	“Are pregnant and undergoing a course of treatment for the pregnancy”
In directory 1/1 plan published	AblePay Health	Member savings page. Not an obstetric code policy.	Any	Any	Any	Any	All	The page describes member savings on pregnancy and delivery out-of-pocket expenses. It states no claim code.	not provided	not provided	not provided	not provided	not provided	deductibles, coinsurance, and copays	not provided	Provided	not provided	awareness_only	not provided	not provided	D67https://ablepayhealth.com/expecting-mothersverified 2026-10-06	“save on out-of-pocket expenses that come with pregnancy and delivery (deductibles, coinsurance, and copays)”
In directory 1/1 plan published	Michigan Medicaid	Proposed policy 2623-Practitioner. July 15 alert remains the primary confirmed link.	<= 12/31/2026 ('through December 31, 2026')	Any	Any	Any	All	MDHHS will continue to require the appropriate maternity care CPT codes through December 31, 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed policy; comments were due October 1, 2026	not provided	not provided	D73https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/Public-Comment/2026/2623-Practitioner-P.pdfverified 2026-10-06	“The Michigan Department of Health and Human Services (MDHHS) will continue to require providers to utilize the appropriate maternity care CPT codes through December 31, 2026.”
In directory 1/1 plan published	Michigan Medicaid	Proposed policy 2623-Practitioner	>= 1/1/2027 ('on and after January 1, 2027')	Any	Any	Any	All	Global maternity CPT codes on or after January 1, 2027 are payable only when every date of service is on or before December 31, 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed policy	not provided	not provided	D73https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/Public-Comment/2026/2623-Practitioner-P.pdfverified 2026-10-06	“Claims submitted with the global maternity care CPT codes on and after January 1, 2027, will be eligible for payment only if all dates of services occurred on or before December 31, 2026.”
In directory 1/1 plan published	Michigan Medicaid	Proposed policy 2623-Practitioner	Any	Any	Any	Any	Antepartum / Postpartum	For the enhanced rate under MSA 14-32, append modifier TH and an obstetric ICD-10-CM diagnosis to routine antepartum and postpartum E/M codes	not provided	TH	appropriate obstetric ICD-10-CM diagnosis code(s)	not provided	not provided	not provided	not provided	Provided	not provided	proposed policy	not provided	not provided	D73https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/Public-Comment/2026/2623-Practitioner-P.pdfverified 2026-10-06	“To be eligible for the enhanced reimbursement rate as outlined within bulletin MSA 14-32 and the Obstetrical Services subsection of the Practitioner Reimbursement Appendix within the MDHHS Medicaid Provider Manual, providers must append modifier TH and the appropriate obstetric International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code(s) to the routine antepartum and postpartum E/M CPT code.”
In directory 1/1 plan published	AmeriHealth Caritas Delaware	Delaware Medicaid	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D74https://p1.amerihealthcaritasde.com/content/dam/amerihealth-caritas/acde/pdf/provider/updates/2026/081126-provider-alert-prenatal-and-postpartum-cpt-communication.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Delaware	Delaware Medicaid	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D74https://p1.amerihealthcaritasde.com/content/dam/amerihealth-caritas/acde/pdf/provider/updates/2026/081126-provider-alert-prenatal-and-postpartum-cpt-communication.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas North Carolina	North Carolina Medicaid	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D75https://www.amerihealthcaritasnc.com/content/dam/amerihealth-caritas/acnc/pdf/provider/news-and-updates/2026/083126-provider-alert-maternity-billing-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas North Carolina	North Carolina Medicaid	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D75https://www.amerihealthcaritasnc.com/content/dam/amerihealth-caritas/acnc/pdf/provider/news-and-updates/2026/083126-provider-alert-maternity-billing-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas North Carolina	NC Medicaid Direct and NC Medicaid Managed Care	>= 9/1/2026 ('beginning September 1, 2026')	Any	Any	Any	Antepartum / Postpartum	Beginning September 1, 2026, NC Medicaid Direct and Managed Care providers are encouraged to use E/M 99202-99215 with modifier TH for prenatal or postpartum care	99202-99215	TH	not provided	not provided	not provided	not provided	encouraged	Provided	not provided	confirmed_2027	not provided	not provided	D75https://www.amerihealthcaritasnc.com/content/dam/amerihealth-caritas/acnc/pdf/provider/news-and-updates/2026/083126-provider-alert-maternity-billing-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“Transition Period: Starting September 1, 2026 To support a smooth transition, beginning September 1, 2026, NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use Evaluation and Management codes (E/M 99202-99215) with the TH modifier, to indicate prenatal or postpartum care.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-delaware	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/de/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-delaware	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/de/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-florida-596906	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/fl/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-florida-596906	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/fl/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-florida-b227e0	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/fl/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-florida-b227e0	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/fl/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-north-carolina	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/nc/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-north-carolina	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/nc/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-louisiana	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/la/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-louisiana	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/la/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-product-of-amerihealth-caritas-louisiana	>= 1/1/2027 ('on or after January 1, 2027')	Any	Any	Any	All	Do not report the bundled prenatal, delivery, and postpartum CPT codes named in the notice	not provided	not provided	not provided	not provided	59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/la/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“The following bundled CPT codes will be retired and should not be reported for dates of service on or after January 1, 2027. 59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622”
In directory 1/1 plan published	AmeriHealth Caritas Next	amerihealth-caritas-next-product-of-amerihealth-caritas-louisiana	>= 1/1/2027 ('effective January 1, 2027')	Any	Any	Any	All	The notice adds these phase-specific CPT codes effective January 1, 2027	59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D76https://www.amerihealthcaritasnext.com/content/dam/amerihealth-caritas/acnext/pdf/la/provider/news-updates/2026/prenatal-and-postpartum-cpt-coding-changes.pdf.coredownload.inline.pdfverified 2026-10-06	“New CPT Code Description 59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623 New codes effective January 1, 2027.”
In directory 1/1 plan published	AmeriHealth Caritas New Hampshire	New Hampshire. FAQ does not list individual CPT codes.	>= 1/1/2027 ('on or after that date')	Any	Any	Any	All	Certain bundled prenatal and postpartum CPT codes are retired beginning January 1, 2027 and should not be reported on or after that date	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D77https://www.amerihealthcaritasnh.com/provider/maternity-codes-faqverified 2026-10-06	“The coding changes take effect January 1, 2027. Retired codes should not be reported for dates of service on or after that date.”
In directory 1/1 plan published	AmeriHealth Caritas New Hampshire	New Hampshire. FAQ does not list individual CPT codes.	>= 1/1/2027 ('on or after that date')	Any	Any	Any	All	Certain bundled prenatal and postpartum CPT codes are retired beginning January 1, 2027 and should not be reported on or after that date	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D77https://www.amerihealthcaritasnh.com/provider/maternity-codes-faqverified 2026-10-06	“The coding changes take effect January 1, 2027. Retired codes should not be reported for dates of service on or after that date.”
In directory 1/1 plan published	Wellpoint Maryland	Maryland Medicaid. Not the New Jersey version.	Any	Any	Any	Any	All	The September 9, 2026 review replaces the global obstetric care package with service-level reimbursement effective January 1, 2027	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	Last approval 09/09/2026; effective 01/01/2027	confirmed_2027	not provided	not provided	D82https://www.wellpoint.com/content/dam/digital/wellpoint/documents/provider/maryland/government/reimbursementpolicies/MD_RP_MaternityServices.pdfverified 2026-10-06	“09/09/2026 - Review approved 09/09/2026 and effective 01/01/2027: updated policy to align with AMA CPT coding changes for maternity care services and to replace the global obstetric care package with service-level reimbursement guidance”
In directory 1/1 plan published	Wellpoint Maryland	Maryland Medicaid	Any	Any	Any	Any	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH. The first prenatal E/M after confirmation must include a Z3A weeks-of-gestation code.	not provided	TH	ICD-10-CM Z3A on the first prenatal E/M after confirmation	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D82https://www.wellpoint.com/content/dam/digital/wellpoint/documents/provider/maryland/government/reimbursementpolicies/MD_RP_MaternityServices.pdfverified 2026-10-06	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH. The first prenatal E/M visit following confirmation of pregnancy, as a condition of reimbursement, must be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation.”
In directory 1/1 plan published	Wellpoint Maryland	Maryland Medicaid	Any	Any	Any	Any	Labor management	Report labor management with CPT 59080-59083. Reimbursement is limited to one service per calendar date, per setting, at the highest level.	59080-59083	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D82https://www.wellpoint.com/content/dam/digital/wellpoint/documents/provider/maryland/government/reimbursementpolicies/MD_RP_MaternityServices.pdfverified 2026-10-06	“Labor management must be reported with CPT ® codes 59080–59083. Reimbursement is limited to one labor management service per calendar date, per setting, at the highest applicable level.”
In directory 1/1 plan published	Wellpoint Maryland	Maryland Medicaid	Any	Any	Any	Any	Delivery	Report delivery with CPT 59431, 59432, 59502, or 59503, plus a Z3A code	59431, 59432, 59502, or 59503	not provided	ICD-10-CM Z3A	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D82https://www.wellpoint.com/content/dam/digital/wellpoint/documents/provider/maryland/government/reimbursementpolicies/MD_RP_MaternityServices.pdfverified 2026-10-06	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable. All professional delivery claims must also be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation at delivery as a condition of reimbursement.”
In directory 1/1 plan published	Wellpoint Maryland	Maryland Medicaid	Any	Any	Any	Any	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH. Z3A is not required.	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D82https://www.wellpoint.com/content/dam/digital/wellpoint/documents/provider/maryland/government/reimbursementpolicies/MD_RP_MaternityServices.pdfverified 2026-10-06	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH. An ICD-10-CM code from category Z3A is not required on postpartum E/M claims.”
In directory 2/2 plans published	Anthem Blue Cross and Blue Shield	Commercial professional. Maine, and Colorado encounters. Not the California exemption.	Any	Any	Any	Any	All	The September 9, 2026 review replaces the global obstetric care package with service-level reimbursement effective January 1, 2027. The California and Virginia exemption is not this row.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	Last approval 09/09/2026; effective 01/01/2027	confirmed_2027	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“09/09/2026 Review approved 09/09/2026 and effective 01/01/2027: • updated policy to align with AMA CPT coding changes for maternity care services and to replace the global obstetric care package with service-level reimbursement guidance; updated Related Coding by adding a code list; updated Definitions section by adding multiple new definitions; • added California and Virginia exemption effective TBD due to delayed implementation”
In directory 2/2 plans published	Anthem Blue Cross and Blue Shield	Commercial professional. Maine, and Colorado encounters.	Any	Any	<= 13	Any	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH, up to 13 routine visits per pregnancy episode per TIN	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH. The health plan allows reimbursement for up to 13 routine office or other outpatient E/M visits per pregnancy episode for services reported under the same federal Tax Identification Number (TIN).”
In directory 2/2 plans published	Anthem Blue Cross and Blue Shield	Commercial professional. Maine, and Colorado encounters.	Any	Any	Any	Any	Labor management	Report labor management with CPT 59080-59083, limited to one service per calendar date, per setting, at the highest level	59080-59083	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“Labor management must be reported with CPT codes 59080–59083. Reimbursement is limited to one labor management service per calendar date, per setting, at the highest applicable level.”
In directory 2/2 plans published	Anthem Blue Cross and Blue Shield	Commercial professional. Maine, and Colorado encounters.	Any	Any	Any	Any	Delivery	Report delivery with CPT 59431, 59432, 59502, or 59503, plus a Z3A code	59431, 59432, 59502, or 59503	not provided	ICD-10-CM Z3A	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable. All professional delivery claims must also be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation at delivery as a condition of reimbursement.”
In directory 2/2 plans published	Anthem Blue Cross and Blue Shield	Commercial professional. Maine, and Colorado encounters.	Any	Any	<= 3	Any	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery per TIN	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH. The health plan allows reimbursement for up to 3 routine office or other outpatient E/M visits per pregnancy episode within 12 weeks after delivery for services reported under the same TIN.”
In directory 1/1 plan published	Anthem Blue Cross California	California commercial. Exemption, not the confirmed service-level rules.	Any	Any	Any	Any	All	Do not apply the 2027 service-level rules as confirmed California billing. The policy adds a California exemption effective TBD because implementation is delayed.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D80https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-06	“09/09/2026 Review approved 09/09/2026 and effective 01/01/2027: • updated policy to align with AMA CPT coding changes for maternity care services and to replace the global obstetric care package with service-level reimbursement guidance; updated Related Coding by adding a code list; updated Definitions section by adding multiple new definitions; • added California and Virginia exemption effective TBD due to delayed implementation”
In directory 1/1 plan published	AmeriChoice by UnitedHealthcare New York	New York Medicaid	>= 1/1/2027 ('as of January 1, 2027')	Any	Any	Any	All	All global and bundled obstetric billing codes will be deleted as of January 1, 2027	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D79https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/bulletins-and-newsletters/NY-Medicaid-Maternity-Code-Changes.pdfverified 2026-10-06	“All global/bundled billing codes for obstetric services will be deleted as of January 1, 2027”
In directory 1/1 plan published	AmeriChoice by UnitedHealthcare New York	New York Medicaid	>= 6/1/2026 ('initiating antepartum services on or after June 1, 2026') and/or	>= 1/1/2027 ('estimated due date on or after January 1, 2027')	Any	Any	Antepartum	New York State Medicaid directs all Medicaid providers to bill E/M codes when antepartum services start on or after June 1, 2026, and/or the estimated due date is on or after January 1, 2027	E/M	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D79https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/bulletins-and-newsletters/NY-Medicaid-Maternity-Code-Changes.pdfverified 2026-10-06	“New York State Medicaid is directing all Medicaid providers to begin to bill Evaluation & Management (E/M) codes for individuals initiating antepartum services on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027.”
In directory 1/1 plan published	AmeriChoice by UnitedHealthcare New York	New York Medicaid	Any	Any	Initial antepartum visit	Any	Antepartum	Routine antepartum care must be billed with an E/M code and modifier TH. The initial antepartum visit must also contain 0500F.	E/M	TH	not provided	0500F	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D79https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/bulletins-and-newsletters/NY-Medicaid-Maternity-Code-Changes.pdfverified 2026-10-06	“Routine antepartum care must be billed using a E/M code with a TH modifier. • The TH modifier will distinguish E/M visits for antepartum services. • Initial antepartum visit must also contain category II CPT code 0500F”
In directory 1/1 plan published	UnitedHealthcare Community Plan	Medicaid. Not Medicare Advantage or AARP.	>= 1/1/2027 ('effective Jan. 1, 2027')	Any	Any	Any	All	CMS was expected to finalize the proposed maternity reporting changes in November 2026. UnitedHealthcare will implement applicable CMS requirements effective January 1, 2027. The instruction is not final.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D81https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-october-2026.pdfverified 2026-10-06	“At the time of publication, CMS has proposed maternity care reporting changes that are expected to be finalized November 2026. UnitedHealthcare will review the final CMS guidance and implement any applicable CMS requirements effective Jan. 1, 2027.”
In directory 1/1 plan published	UnitedHealthcare Community Plan	Medicaid	>= 1/1/2027	Any	Any	Any	All	If CMS finalizes the proposed 2027 maternity HCPCS G-codes, report those G-codes. If not, CPT maternity care leaves global reporting effective January 1, 2027.	applicable CMS-designated HCPCS G-codes, if finalized	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D81https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-october-2026.pdfverified 2026-10-06	“If CMS finalizes its proposed 2027 maternity HCPCS G-codes, providers should report maternity services using the applicable CMS-designated HCPCS G-codes. If the CMS proposal is not finalized, effective Jan. 1, 2027, CPT® maternity care services will transition from global obstetric reporting to phase-based reporting, including antepartum, labor management, delivery, and postpartum care.”
In directory 1/1 plan published	UnitedHealthcare Community Plan	Medicaid	<= 12/31/2026 ('on or before Dec. 31, 2026')	Any	Any	Any	All	Report services rendered on or before December 31, 2026 under CPT 2026, including 59425, 59426, or an E/M code	59425, 59426, or applicable E/M	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D81https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-october-2026.pdfverified 2026-10-06	“Services rendered on or before Dec. 31, 2026, should be reported in accordance with CPT® 2026 guidelines, including CPT® 59425, 59426, or applicable E/M services.”
In directory 1/1 plan published	UnitedHealthcare Community Plan	Medicaid	>= 1/1/2027 ('on or after Jan. 1, 2027')	Any	Any	Any	All	Report services rendered on or after January 1, 2027 with the appropriate E/M code. Antepartum-only global obstetric CPT codes no longer apply in 2027.	appropriate E/M code	not provided	not provided	not provided	Antepartum-only global obstetric CPT codes	not provided	not provided	Provided	not provided	proposed_not_final	not provided	not provided	D81https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/rpub/community-plan-reimbursement-update-bulletin-october-2026.pdfverified 2026-10-06	“Services rendered on or after Jan. 1, 2027, should be reported using the appropriate E/M code. Antepartum-only global obstetric CPT® codes will no longer apply to services rendered in 2027 and beyond.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	>= 9/1/2026 ('beginning prenatal care on or after September 1, 2026')	Any	Any	Any	Antepartum	For new maternity patients beginning prenatal care on or after September 1, 2026, prenatal visits may be billed with E/M codes, modifier TH, and a pregnancy diagnosis	not provided	TH	appropriate pregnancy diagnosis	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“For new maternity patients beginning prenatal care on or after September 1, 2026, prenatal visits may be billed using Evaluation and Management (E&M) codes with modifier TH and an appropriate pregnancy diagnosis, consistent with AMA transition guidance.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	Any	<= 12/31/2026 ('deliveries occurring in 2026')	Any	Any	All	Existing global maternity coding guidance remains applicable for qualifying pregnancies and deliveries occurring in 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Existing global maternity coding guidance remains applicable for qualifying pregnancies and deliveries occurring in 2026.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	>= 1/1/2027	Any	Any	Any	All	Beginning January 1, 2027, report maternity care across four phases: antepartum, labor management, delivery, and postpartum	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Beginning January 1, 2027, the longstanding global maternity coding framework will be replaced with a service-level coding structure. Under the new model, maternity care will be reported across four phases: • Antepartum (prenatal) care • Labor management • Delivery care • Postpartum care”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid. OHCA rule quoted by the plan newsletter.	<= 12/31/2026 ('before January 1, 2027')	Any	<= 3	Any	Antepartum	For antepartum services before January 1, 2027, bill one to three visits as individual E/M codes	individual E/M codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“One to three visits: bill individual E/M codes.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid. OHCA rule quoted by the plan newsletter.	<= 12/31/2026 ('before January 1, 2027')	Any	4-6	Any	Antepartum	For antepartum services before January 1, 2027, bill four to six visits as CPT 59425 for the first block, then individual E/M codes for additional visits	59425, then individual E/M codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Four to six visits: bill CPT code 59425 for the first block of visits, then use individual E/M codes for additional visits.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid. OHCA rule quoted by the plan newsletter.	<= 12/31/2026 ('before January 1, 2027')	Any	>= 7	Any	Antepartum	For antepartum services before January 1, 2027, bill seven or more visits as CPT 59426	59426	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“For antepartum services provided before January 1, 2027: One to three visits: bill individual E/M codes. Four to six visits: bill CPT code 59425 for the first block of visits, then use individual E/M codes for additional visits. Seven or more visits: bill CPT code 59426.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	Any	< 1/1/2027 ('before January 1, 2027')	Any	Any	Delivery	Deliveries before January 1, 2027 may continue using current bundled maternity codes	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Deliveries before January 1, 2027: providers may continue using current bundled maternity codes.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	Any	>= 1/1/2027 ('delivery in 2027')	Any	Any	Delivery	Prenatal care in 2026 with delivery in 2027 cannot use bundled delivery codes	not provided	not provided	not provided	not provided	bundled delivery codes	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Prenatal care in 2026 with delivery in 2027: bundled delivery codes cannot be used.”
In directory 1/1 plan published	Aetna Better Health of Oklahoma	SoonerSelect Medicaid	Any	Any	Any	Any	Antepartum / Postpartum	Apply modifier TH to E/M codes when billing antepartum or postpartum care	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D71https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/Maternity_code_unbundling_notice_FINAL.pdfverified 2026-10-06	“Apply the TH modifier to E/M codes when billing for antepartum or postpartum care to support proper claims processing and help prevent denials.”
In directory 1/1 plan published	Aetna Better Health of Michigan	Medicaid letter relaying proposed MDHHS policy	>= 1/1/2027 ('Effective January 1, 2027')	Any	Any	Any	All	Do not treat this as a confirmed plan rule. The letter says that effective January 1, 2027 the global maternity CPT codes (for example 59400, 59510, 59620) are being deleted and separate CPT codes reported.	not provided	not provided	not provided	not provided	59400, 59510, 59620	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D72https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/michigan/provider/pdf/abhmi_Updates_to_Coverage_of_Maternity_Care_Services.pdfverified 2026-10-06	“Effective January 1, 2027, the AMA CPT Editorial Panel is deleting the current global maternity care CPT codes representative of antepartum, labor and delivery and postpartum care services (e.g., 59400, 59510, 59620) and transitioning to the reporting of separate CPT codes for services rendered.”
In directory 1/1 plan published	Blue Cross Blue Shield of Michigan	Commercial	>= 1/1/2027 ('on Jan. 1, 2027')	Any	Any	Any	All	Global bundled prenatal, delivery, and postpartum codes are discontinued Jan. 1, 2027 and replaced with individual E/M or designated obstetric procedure codes	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The American Medical Association, or AMA, will discontinue global, bundled payment codes for prenatal, delivery and postpartum care on Jan. 1, 2027, and replace them with individual evaluation and management, or E/M, or designated obstetric procedure codes.”
In directory 1/1 plan published	Blue Cross Blue Shield of Michigan	Commercial	Any	>= 1/1/2027 ('expected to deliver on or after Jan. 1, 2027')	Any	Any	Antepartum	The TH modifier is a prerequisite for processing prenatal claims that use the designated E/M codes, for members expected to deliver on or after Jan. 1, 2027	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The use of the TH modifier will be a prerequisite for processing all prenatal claims using the designated E/M codes.”
In directory 1/1 plan published	BCBS Michigan and Blue Care Network	Blue Care Network commercial	>= 1/1/2027 ('on Jan. 1, 2027')	Any	Any	Any	All	Global bundled prenatal, delivery, and postpartum codes are discontinued Jan. 1, 2027 and replaced with individual E/M or designated obstetric procedure codes	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The American Medical Association, or AMA, will discontinue global, bundled payment codes for prenatal, delivery and postpartum care on Jan. 1, 2027, and replace them with individual evaluation and management, or E/M, or designated obstetric procedure codes.”
In directory 1/1 plan published	BCBS Michigan and Blue Care Network	Blue Care Network commercial	Any	>= 1/1/2027 ('expected to deliver on or after Jan. 1, 2027')	Any	Any	Antepartum	The TH modifier is a prerequisite for processing prenatal claims that use the designated E/M codes, for members expected to deliver on or after Jan. 1, 2027	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The use of the TH modifier will be a prerequisite for processing all prenatal claims using the designated E/M codes.”
In directory 1/1 plan published	Blue Cross Blue Shield of Michigan Medicare Advantage	Medicare Plus Blue and BCN Advantage	>= 1/1/2027 ('on Jan. 1, 2027')	Any	Any	Any	All	Global bundled prenatal, delivery, and postpartum codes are discontinued Jan. 1, 2027 and replaced with individual E/M or designated obstetric procedure codes	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The American Medical Association, or AMA, will discontinue global, bundled payment codes for prenatal, delivery and postpartum care on Jan. 1, 2027, and replace them with individual evaluation and management, or E/M, or designated obstetric procedure codes.”
In directory 1/1 plan published	Blue Cross Blue Shield of Michigan Medicare Advantage	Medicare Plus Blue and BCN Advantage	Any	>= 1/1/2027 ('expected to deliver on or after Jan. 1, 2027')	Any	Any	Antepartum	The TH modifier is a prerequisite for processing prenatal claims that use the designated E/M codes, for members expected to deliver on or after Jan. 1, 2027	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D84https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2026/aug/Record_0826a.htmlverified 2026-10-06	“The use of the TH modifier will be a prerequisite for processing all prenatal claims using the designated E/M codes.”
In directory 1/1 plan published	Blue Shield of California	Network providers	>= 1/1/2027	Any	Any	Any	All	Effective January 1, 2027, bill maternity services with a phase-of-care methodology rather than a global obstetrical package	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D85https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/Maternity-CPT-Code-FAQ.pdfverified 2026-10-06	“effective January 1, 2027, Blue Shield of California will require maternity services to be billed in accordance with current AMA CPT coding guidelines, to be reported using a phase-of-care methodology rather than a global obstetrical package.”
In directory 1/1 plan published	Blue Shield of California	Network providers	Any	>= 1/1/2027 ('continue past January 1, 2027')	<= 3	Any	Antepartum	When one to three antepartum visits were completed by September 1, 2026, bill E/M codes for continuing antepartum visits anticipated to continue past January 1, 2027	E/M	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D85https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/Maternity-CPT-Code-FAQ.pdfverified 2026-10-06	“For patients who have completed one to three antepartum care visits with your practice by September 1, 2026, we request that you begin billing E&M codes for your patient's continuing antepartum visits which are anticipated to continue past January 1, 2027”
In directory 1/1 plan published	Blue Shield of California	Network providers	Any	<= 12/31/2026 ('delivering by 12-31-2026')	>= 4	Any	All	Four or more visits as of September 1, 2026 continue under the global CPT structure for patients delivering by December 31, 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D85https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/Maternity-CPT-Code-FAQ.pdfverified 2026-10-06	“For patients who have completed four or more visits as of September 1, 2026, Blue Shield advises your practice to continue billing under the Global CPT structure for patients delivering by 12-31-2026”
In directory 1/1 plan published	AZ Blue	Medicaid	Any	Any	4-6	Any	Antepartum	Bill 4-6 antepartum visits with CPT 59425	59425	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D86https://www.azblue.com/medicaid/provider-newsletter/q326/maternity-billing-guidanceverified 2026-10-06	“4-6 antepartum visits CPT 59425”
In directory 1/1 plan published	AZ Blue	Medicaid	Any	Any	>= 7	Any	Antepartum	Bill 7 or more antepartum visits with CPT 59426	59426	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D86https://www.azblue.com/medicaid/provider-newsletter/q326/maternity-billing-guidanceverified 2026-10-06	“7 or more antepartum visits CPT 59426”
In directory 1/1 plan published	AZ Blue	Medicaid	Any	Any	<= 3	Any	Antepartum	Fewer than 4 antepartum visits continue to follow current 2026 CPT coding	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D86https://www.azblue.com/medicaid/provider-newsletter/q326/maternity-billing-guidanceverified 2026-10-06	“Fewer than 4 antepartum visits Continue to follow current 2026 CPT coding”
In directory 1/1 plan published	BCBS North Dakota	bcbs-north-dakota-72dc21	>= 1/1/2027 ('Jan. 1, 2027')	Any	Any	Any	All	Maternity global coding changes will take effect Jan. 1, 2027. Final guidance and education materials are promised in December. No code-level rule is stated.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	December	D87https://www.bcbsnd.com/providers/news-resources/healthcare-news/preparing-for-maternity-global-coding-changes-effective-jan-1-20verified 2026-10-06	“BCBSND is sharing additional details regarding maternity global coding changes that will take effect Jan. 1, 2027.”
In directory 1/1 plan published	BCBS North Dakota	bcbs-north-dakota-cb1b6a	>= 1/1/2027 ('Jan. 1, 2027')	Any	Any	Any	All	Maternity global coding changes will take effect Jan. 1, 2027. Final guidance and education materials are promised in December. No code-level rule is stated.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	December	D87https://www.bcbsnd.com/providers/news-resources/healthcare-news/preparing-for-maternity-global-coding-changes-effective-jan-1-20verified 2026-10-06	“maternity global coding changes that will take effect Jan. 1, 2027.”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	Obstetric claims	>= 9/1/2026 ('on or after September 1, 2026')	Any	Initial prenatal visit	Any	Antepartum	If the first visit after confirmation of pregnancy is on or after September 1, 2026, bill E/M with modifier -TH and Z34.XX or O00-O9A	not provided	TH	Z34.XX or O00-O9A	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D88https://www.bluecrossvt.org/documents/provider-changes-maternity-care-services-coding-and-billing-october-2026verified 2026-10-06	“If the first visit after confirmation of pregnancy occurs on or after September 1, 2026, bill the appropriate E/M code appended with the modifier -TH and an appropriate Z34.XX or O00-O9A diagnosis code.”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	Obstetric claims	Any	<= 12/31/2026 ('delivery in 2026')	Any	Any	Delivery	A vaginal or cesarean delivery in 2026 uses the appropriate current global obstetrics codes	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D88https://www.bluecrossvt.org/documents/provider-changes-maternity-care-services-coding-and-billing-october-2026verified 2026-10-06	“Vaginal or cesarean delivery in 2026 \| Use the appropriate current global obstetrics codes”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	Obstetric claims	Any	>= 1/1/2027 ('delivery in 2027')	>= 7	Any	Antepartum	Seven or more antepartum visits in 2026 with delivery in 2027 use CPT 59426	59426	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D88https://www.bluecrossvt.org/documents/provider-changes-maternity-care-services-coding-and-billing-october-2026verified 2026-10-06	“7 or more antepartum visits in 2026 with delivery in 2027 \| Use CPT 59426”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	Obstetric claims	Any	>= 1/1/2027 ('delivery in 2027')	4-6	Any	Antepartum	Four to six antepartum visits in 2026 with delivery in 2027 use CPT 59425	59425	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D88https://www.bluecrossvt.org/documents/provider-changes-maternity-care-services-coding-and-billing-october-2026verified 2026-10-06	“4-6 antepartum visits in 2026 with delivery in 2027 \| Use CPT 59425”
In directory 1/1 plan published	Highmark	Professional and facility. This catalog ID only.	>= 10/1/2026 ('on Oct. 1, 2026')	>= 1/1/2027 ('due dates on or after Jan. 1, 2027')	Any	Any	Antepartum	For due dates on or after Jan. 1, 2027, begin the new model on Oct. 1, 2026 with E/M codes and modifier TH only	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D95https://providers.highmark.com/communications-hub/news-and-updates/guidance-on-new-coding-and-billing-model-for-maternity-care.htmlverified 2026-10-06	“For pregnant members with due dates on or after Jan. 1, 2027, providers should begin transitioning to the new billing model on Oct. 1, 2026, by utilizing evaluation and management (E/M) codes with the TH modifier only.”
In directory 1/1 plan published	Highmark	Professional and facility	Any	Any	>= 7	Any	Antepartum	Seven or more antepartum visits bill CPT 59426	59426	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D95https://providers.highmark.com/communications-hub/news-and-updates/guidance-on-new-coding-and-billing-model-for-maternity-care.htmlverified 2026-10-06	“7 or more antepartum visits (CPT 59426)”
In directory 1/1 plan published	Highmark	Professional and facility	Any	Any	4-6	Any	Antepartum	Four to six antepartum visits bill CPT 59425	59425	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D95https://providers.highmark.com/communications-hub/news-and-updates/guidance-on-new-coding-and-billing-model-for-maternity-care.htmlverified 2026-10-06	“4-6 antepartum visits (CPT 59425)”
In directory 1/1 plan published	Highmark	Professional and facility	Any	Any	<= 3	Any	Antepartum	Fewer than 4 antepartum visits bill E/M codes with the TH modifier	not provided	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D95https://providers.highmark.com/communications-hub/news-and-updates/guidance-on-new-coding-and-billing-model-for-maternity-care.htmlverified 2026-10-06	“Fewer than 4 antepartum visits (E/M codes with TH modifier)”
In directory 1/1 plan published	South Dakota Medicaid	Medicaid	<= 12/31/2026 ('through December 31, 2026')	Any	Any	Any	All	Global obstetric codes remain valid for dates of service through December 31, 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D90https://dss.sd.gov/docs/medicaid/providers/Communication/2026/09.04_Obstetrical_Services_Billing_Changes.pdfverified 2026-10-06	“Global obstetric codes remain valid for dates of service through December 31, 2026.”
In directory 1/1 plan published	South Dakota Medicaid	Medicaid	Any	Any	Any	Any	Antepartum	Antepartum care may be billed per encounter with E/M 99202-99499, a pregnancy-related ICD-10-CM code, and modifier TH for routine prenatal E/M	99202-99499	TH	pregnancy-related ICD-10-CM	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D90https://dss.sd.gov/docs/medicaid/providers/Communication/2026/09.04_Obstetrical_Services_Billing_Changes.pdfverified 2026-10-06	“Antepartum \| May be billed per encounter using the appropriate E/M procedure codes (CPT 99202–99499). All claims must include pregnancy-related ICD-10-CM diagnosis codes. The TH modifier should be applied when billing routine prenatal care EM codes.”
In directory 1/1 plan published	South Dakota Medicaid	Medicaid	Any	Any	Any	Any	Delivery	Labor and delivery may be billed with delivery-only codes 59409, 59514, 59612, or 59620	59409, 59514, 59612, 59620	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D90https://dss.sd.gov/docs/medicaid/providers/Communication/2026/09.04_Obstetrical_Services_Billing_Changes.pdfverified 2026-10-06	“May be billed per delivery using the current delivery-only codes (CPT 59409, 59514, 59612, 59620).”
In directory 1/1 plan published	South Dakota Medicaid	Medicaid	Any	Any	Any	Any	Postpartum	Postpartum care may be billed per encounter with E/M 99202-99499, diagnosis Z39.2, and modifier TH for routine postpartum E/M	99202-99499	TH	Z39.2	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D90https://dss.sd.gov/docs/medicaid/providers/Communication/2026/09.04_Obstetrical_Services_Billing_Changes.pdfverified 2026-10-06	“Postpartum Care May be billed per encounter using appropriate E/M procedure codes (CPT 99202–99499). Diagnosis code Z39.2 must be used to indicate routine postpartum follow-up care. The TH modifier should be applied when billing routine postpartum care EM codes.”
In directory 1/1 plan published	Ohio Medicaid	Fee-for-service	>= 1/1/2027 ('beginning January 1, 2027')	Any	Any	Any	All	Beginning January 1, 2027, current Maternity Care Services global and bundled codes are discontinued and CPT services are separately reportable	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D91https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families,%20Individuals/Programs/MISP/ODM_Maternity_Codes_Bulletin_7.17.2026.pdfverified 2026-10-06	“beginning January 1, 2027, the current Maternity Care Services global and/or bundled codes will be discontinued. Under the new coding structure, services and procedures represented by CPT codes are separately reportable.”
In directory 1/1 plan published	Ohio Medicaid	Fee-for-service	>= 9/1/2026 ('on or after September 1, 2026')	Any	Initial prenatal visit	Any	Antepartum	The first prenatal visit after confirmation of pregnancy on or after September 1, 2026 requires an E/M code and ICD-10-CM codes, including weeks of gestation from Z23A	E/M	not provided	ICD-10-CM, including weeks of gestation (Z23A as printed)	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D91https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families,%20Individuals/Programs/MISP/ODM_Maternity_Codes_Bulletin_7.17.2026.pdfverified 2026-10-06	“ODM will require the use of E/M codes for patients presenting for their first prenatal visit after confirmation of pregnancy on or after September 1, 2026, along with the appropriate ICD-10-CM codes, including the weeks of gestation (i.e., codes from Z23A)”
In directory 1/1 plan published	MetroPlusHealth	Medicaid, HARP, HIV-SNP	>= 1/1/2027	Any	Any	Any	All	Effective January 1, 2027, global obstetric codes are replaced by itemized visit-level codes and are no longer payable	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D92https://metroplus.org/wp-content/uploads/2026/07/PRV-26.083_NYSDOH-Changes-to-Global-Obstetric-Codes-for-Prenatal_FINAL8.6.2026.pdfverified 2026-10-06	“Effective January 1, 2027, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) will replace global obstetric (OB) codes with itemized, visit-level billing codes. These global obstetric codes will no longer be payable after the effective date.”
In directory 1/1 plan published	MetroPlusHealth	Medicaid, HARP, HIV-SNP	>= 6/1/2026 ('effective June 1, 2026')	Any	Any	Any	All	New York Medicaid adopted these coding changes effective June 1, 2026	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D92https://metroplus.org/wp-content/uploads/2026/07/PRV-26.083_NYSDOH-Changes-to-Global-Obstetric-Codes-for-Prenatal_FINAL8.6.2026.pdfverified 2026-10-06	“New York Medicaid adopted these coding changes effective June 1, 2026”
In directory 1/1 plan published	New Mexico Medicaid	Medicaid	Any	< 1/1/2027 ('prior to January 1, 2027')	Any	Any	All	A delivery prior to January 1, 2027 continues under current guidelines	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D93https://www.hca.nm.gov/wp-content/uploads/Unbundling-Global-Maternity-Services-Announcement-FINAL.pdfverified 2026-10-06	“For any Medicaid member that has a delivery prior to January 1, 2027, please continue billing under the current guidelines.”
In directory 1/1 plan published	New Mexico Medicaid	Medicaid	5/15/2026 - 7/14/2026 (first 10-week visit)	Any	Any	Any	Antepartum	A first 10-week visit between May 15, 2026 and July 14, 2026 uses 59426 plus delivery only	59426	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D93https://www.hca.nm.gov/wp-content/uploads/Unbundling-Global-Maternity-Services-Announcement-FINAL.pdfverified 2026-10-06	“For pregnancies with a first 10-week visit between May 15, 2026, to July 14, 2026: Use 59426 (antepartum care only; 7 or more visits) + delivery only.”
In directory 1/1 plan published	New Mexico Medicaid	Medicaid	7/15/2026 - 8/30/2026 (first 10-week visit)	Any	Any	Any	Antepartum	A first 10-week visit between July 15, 2026 and August 30, 2026 uses 59425 plus delivery only	59425	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D93https://www.hca.nm.gov/wp-content/uploads/Unbundling-Global-Maternity-Services-Announcement-FINAL.pdfverified 2026-10-06	“For pregnancies with a first 10-week visit between July 15, 2026, to August 30, 2026: Use 59425 (antepartum care only; 4 or 6 more visit”
In directory 1/1 plan published	Nevada Medicaid	Medicaid and managed care	Any	Any	Any	Any	All	Do not adopt the new code structure on January 1, 2027. Continue the current bundled code structure until Nevada Medicaid changes the policy.	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	current_policy_only	not provided	not provided	D94https://www.medicaid.nv.gov/Downloads/provider/web_announcement_4024_20261002.pdfverified 2026-10-06	“At this time, Nevada Medicaid, including Nevada Medicaid's managed care organizations (MCOs) will not adopt this new code structure on January 1, 2027.”
In directory 1/1 plan published	Virginia Medicaid	medicaid-virginia-d86ec3	Any	Any	Initial prenatal visit	Any	Antepartum	The stored quote says 0500F on all initial prenatal visits, until additional implementation guidance is issued	not provided	not provided	not provided	0500F	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D58https://vamedicaid.dmas.virginia.gov/vamed/download-pdf-bulletin/22649verified 2026-10-06	“0500F on all initial prenatal visits”
In directory 1/1 plan published	Virginia Medicaid	medicaid-virginia-1ded25	Any	Any	Initial prenatal visit	Any	Antepartum	The stored quote says 0500F on all initial prenatal visits, until additional implementation guidance is issued	not provided	not provided	not provided	0500F	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D58https://vamedicaid.dmas.virginia.gov/vamed/download-pdf-bulletin/22649verified 2026-10-06	“0500F on all initial prenatal visits”
In directory 1/1 plan published	Nebraska Medicaid	Managed care advisory	Any	Any	Any	Any	All	The stored quote names 99202-99499 and the TH modifier. It does not state the cohort.	99202-99499	TH	not provided	not provided	not provided	not provided	not provided	Provided	not provided	pending_guidance	not provided	not provided	D59https://dhhs.ne.gov/Medicaid%20Health%20Plan%20Advisories/Health%20Plan%20Advisory%2026-12.pdfverified 2026-10-06	“99202-99499 and utilize the TH modifier”
In directory 1/1 plan published	Medi-Cal	California Medi-Cal. Not an individual managed-care plan.	>= 11/1/2026 ('Starting on November 1, 2026')	Any	Any	Any	Antepartum / Postpartum	Starting on November 1, 2026, Medi-Cal encourages obstetrical E/M billing and says modifier TH must be included	not provided	TH	not provided	not provided	not provided	not provided	encouraged	Provided	not provided	confirmed_2027	not provided	not provided	D60https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34130.01verified 2026-10-06	“Starting on November 1, 2026, Medi-Cal encourages”
In directory 1/1 plan published	Medi-Cal	CPSP providers and doulas	Any	Any	Any	Any	All	CPSP providers and doulas must continue to use local Z codes until further notice	local Z codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided	not provided	confirmed_2027	not provided	not provided	D60https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34130.01verified 2026-10-06	“must continue to use local Z codes”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield HP	Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties	>= 1/1/2027	Any	<= 13	Routine office or other outpatient	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH, up to 13 routine visits per pregnancy episode under the same TIN	Applicable E/M code	TH	ICD-10-CM category Z3A on the first prenatal E/M visit	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield HP	Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties	>= 1/1/2027	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	The first prenatal E/M visit is inside the 13-visit limit and must be reported with a Z3A weeks-of-gestation code	Applicable E/M code	TH	ICD-10-CM category Z3A identifying completed weeks of gestation	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“The first prenatal E/M visit following confirmation of pregnancy is included in the 13-visit limit and, as a condition of reimbursement, must be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield HP	Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties	>= 1/1/2027	Any	Any	Any	Labor management	Report labor management with CPT codes 59080-59083	59080–59083	not provided	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Labor management must be reported with CPT codes 59080–59083.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield HP	Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties	>= 1/1/2027	Any	Any	Any	Delivery	Report delivery with 59431, 59432, 59502, or 59503, and a Z3A code for completed weeks of gestation at delivery	59431, 59432, 59502, or 59503	not provided	ICD-10-CM category Z3A identifying completed weeks of gestation at delivery	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield HP	Commercial; Anthem HP, LLC, trade name Anthem Blue Cross and Blue Shield HP, in 17 southeastern New York counties	>= 1/1/2027	Any	<= 3	Routine office or other outpatient within 12 weeks after delivery	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery under the same TIN	Applicable E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Colorado	Commercial; Rocky Mountain Hospital and Medical Service, Inc. in Colorado. HMO products underwritten by HMO Colorado, Inc.	>= 1/1/2027	Any	<= 13	Routine office or other outpatient	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH, up to 13 routine visits per pregnancy episode under the same TIN	Applicable E/M code	TH	ICD-10-CM category Z3A on the first prenatal E/M visit	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Colorado	Commercial; Rocky Mountain Hospital and Medical Service, Inc. in Colorado. HMO products underwritten by HMO Colorado, Inc.	>= 1/1/2027	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	The first prenatal E/M visit is inside the 13-visit limit and must be reported with a Z3A weeks-of-gestation code	Applicable E/M code	TH	ICD-10-CM category Z3A identifying completed weeks of gestation	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“The first prenatal E/M visit following confirmation of pregnancy is included in the 13-visit limit and, as a condition of reimbursement, must be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Colorado	Commercial; Rocky Mountain Hospital and Medical Service, Inc. in Colorado. HMO products underwritten by HMO Colorado, Inc.	>= 1/1/2027	Any	Any	Any	Labor management	Report labor management with CPT codes 59080-59083	59080–59083	not provided	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Labor management must be reported with CPT codes 59080–59083.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Colorado	Commercial; Rocky Mountain Hospital and Medical Service, Inc. in Colorado. HMO products underwritten by HMO Colorado, Inc.	>= 1/1/2027	Any	Any	Any	Delivery	Report delivery with 59431, 59432, 59502, or 59503, and a Z3A code for completed weeks of gestation at delivery	59431, 59432, 59502, or 59503	not provided	ICD-10-CM category Z3A identifying completed weeks of gestation at delivery	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Colorado	Commercial; Rocky Mountain Hospital and Medical Service, Inc. in Colorado. HMO products underwritten by HMO Colorado, Inc.	>= 1/1/2027	Any	<= 3	Routine office or other outpatient within 12 weeks after delivery	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery under the same TIN	Applicable E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Georgia	Commercial; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	>= 1/1/2027	Any	<= 13	Routine office or other outpatient	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH, up to 13 routine visits per pregnancy episode under the same TIN	Applicable E/M code	TH	ICD-10-CM category Z3A on the first prenatal E/M visit	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Georgia	Commercial; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	>= 1/1/2027	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	The first prenatal E/M visit is inside the 13-visit limit and must be reported with a Z3A weeks-of-gestation code	Applicable E/M code	TH	ICD-10-CM category Z3A identifying completed weeks of gestation	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“The first prenatal E/M visit following confirmation of pregnancy is included in the 13-visit limit and, as a condition of reimbursement, must be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Georgia	Commercial; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	>= 1/1/2027	Any	Any	Any	Labor management	Report labor management with CPT codes 59080-59083	59080–59083	not provided	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Labor management must be reported with CPT codes 59080–59083.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Georgia	Commercial; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	>= 1/1/2027	Any	Any	Any	Delivery	Report delivery with 59431, 59432, 59502, or 59503, and a Z3A code for completed weeks of gestation at delivery	59431, 59432, 59502, or 59503	not provided	ICD-10-CM category Z3A identifying completed weeks of gestation at delivery	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Georgia	Commercial; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.	>= 1/1/2027	Any	<= 3	Routine office or other outpatient within 12 weeks after delivery	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery under the same TIN	Applicable E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Indiana	Commercial; Anthem Insurance Companies, Inc. in Indiana	>= 1/1/2027	Any	<= 13	Routine office or other outpatient	Antepartum	Report antepartum care per encounter with the applicable E/M code and modifier TH, up to 13 routine visits per pregnancy episode under the same TIN	Applicable E/M code	TH	ICD-10-CM category Z3A on the first prenatal E/M visit	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Antepartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Indiana	Commercial; Anthem Insurance Companies, Inc. in Indiana	>= 1/1/2027	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	The first prenatal E/M visit is inside the 13-visit limit and must be reported with a Z3A weeks-of-gestation code	Applicable E/M code	TH	ICD-10-CM category Z3A identifying completed weeks of gestation	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“The first prenatal E/M visit following confirmation of pregnancy is included in the 13-visit limit and, as a condition of reimbursement, must be reported with an applicable ICD-10-CM code from category Z3A identifying the completed weeks of gestation.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Indiana	Commercial; Anthem Insurance Companies, Inc. in Indiana	>= 1/1/2027	Any	Any	Any	Labor management	Report labor management with CPT codes 59080-59083	59080–59083	not provided	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Labor management must be reported with CPT codes 59080–59083.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Indiana	Commercial; Anthem Insurance Companies, Inc. in Indiana	>= 1/1/2027	Any	Any	Any	Delivery	Report delivery with 59431, 59432, 59502, or 59503, and a Z3A code for completed weeks of gestation at delivery	59431, 59432, 59502, or 59503	not provided	ICD-10-CM category Z3A identifying completed weeks of gestation at delivery	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Delivery must be reported with CPT code 59431, 59432, 59502, or 59503, as applicable.”
In directory 1/1 plan published	Anthem Blue Cross Blue Shield of Indiana	Commercial; Anthem Insurance Companies, Inc. in Indiana	>= 1/1/2027	Any	<= 3	Routine office or other outpatient within 12 weeks after delivery	Postpartum	Report postpartum care per encounter with the applicable E/M code and modifier TH, up to 3 routine visits within 12 weeks after delivery under the same TIN	Applicable E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Last approval 09/09/2026; effective 01/01/2027	operational	not provided	not provided	D96https://www.anthembluecross.com/content/dam/digital/docs/provider/commercial/policy/reimb/C-19005.pdfverified 2026-10-08	“Postpartum care must be reported per encounter with the applicable E/M code and modifier TH.”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Initial prenatal visit	Initial prenatal visit	Antepartum	Bill 0500F on the initial visit with the appropriate E/M code and modifier TH. 0500F is not separately reimbursable	Appropriate E/M code	TH	Pregnancy-related ICD-10 diagnosis code	0500F	not provided	not provided	should	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“0500F should be billed on the initial visit in conjunction”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Any	Antepartum	Report antepartum care with the appropriate E/M code and append modifier TH	Appropriate E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Modifier TH (obstetrical treatment/services, prenatal or postpartum) must be appended”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Any	All	Maternity care codes are not eligible for reimbursement for dates of service on or after January 1, 2027	not provided	not provided	not provided	not provided	Maternity care codes eligible before January 1, 2027	not provided	will	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“maternity care codes will not be eligible for reimbursement for dates of service on or after Jan. 1, 2027.”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Any	Labor management	Labor management may be reported once per calendar date	not provided	not provided	not provided	not provided	not provided	not provided	may	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Labor management may be reported once per calendar date”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Any	Labor management	Labor management is not separately reimbursable when the patient presents for a scheduled or planned cesarean delivery and labor does not occur	not provided	not provided	not provided	not provided	Separate labor management when a scheduled or planned cesarean has no labor	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Labor management is not separately reimbursable when the patient presents for a scheduled or planned cesarean delivery”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Multiple gestation	Delivery	Report one appropriate vaginal delivery code per fetus. Only one cesarean delivery code is eligible regardless of the number of fetuses	One appropriate vaginal delivery code per fetus	not provided	not provided	not provided	More than one cesarean delivery code for the same delivery	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“only one cesarean delivery code is eligible for reimbursement, regardless of the number of”
In directory 1/1 plan published	Medical Mutual	Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company	>= 1/1/2027	Any	Any	Any	Postpartum	Immediate maternal postpartum care on the same calendar date as delivery is included in delivery care and is not separately reimbursable	not provided	not provided	not provided	not provided	Separate immediate maternal postpartum care on the delivery date	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Immediate maternal postpartum care performed on the same calendar date as delivery is included in the delivery care”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Initial prenatal visit	Initial prenatal visit	Antepartum	Bill 0500F on the initial visit with the appropriate E/M code and modifier TH. 0500F is not separately reimbursable	Appropriate E/M code	TH	Pregnancy-related ICD-10 diagnosis code	0500F	not provided	not provided	should	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“0500F should be billed on the initial visit in conjunction”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Any	Antepartum	Report antepartum care with the appropriate E/M code and append modifier TH	Appropriate E/M code	TH	not provided	not provided	not provided	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Modifier TH (obstetrical treatment/services, prenatal or postpartum) must be appended”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Any	All	Maternity care codes are not eligible for reimbursement for dates of service on or after January 1, 2027	not provided	not provided	not provided	not provided	Maternity care codes eligible before January 1, 2027	not provided	will	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“maternity care codes will not be eligible for reimbursement for dates of service on or after Jan. 1, 2027.”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Any	Labor management	Labor management may be reported once per calendar date	not provided	not provided	not provided	not provided	not provided	not provided	may	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Labor management may be reported once per calendar date”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Any	Labor management	Labor management is not separately reimbursable when the patient presents for a scheduled or planned cesarean delivery and labor does not occur	not provided	not provided	not provided	not provided	Separate labor management when a scheduled or planned cesarean has no labor	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Labor management is not separately reimbursable when the patient presents for a scheduled or planned cesarean delivery”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Multiple gestation	Delivery	Report one appropriate vaginal delivery code per fetus. Only one cesarean delivery code is eligible regardless of the number of fetuses	One appropriate vaginal delivery code per fetus	not provided	not provided	not provided	More than one cesarean delivery code for the same delivery	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“only one cesarean delivery code is eligible for reimbursement, regardless of the number of”
In directory 1/1 plan published	Mutual Health Services	Commercial (Self-Funded); Mutual Health Services only	>= 1/1/2027	Any	Any	Any	Postpartum	Immediate maternal postpartum care on the same calendar date as delivery is included in delivery care and is not separately reimbursable	not provided	not provided	not provided	not provided	Separate immediate maternal postpartum care on the delivery date	not provided	must	Provided	Policy created and initially effective 01/01/2027	operational	not provided	not provided	D97https://www.medmutual.com/-/media/MedMutual/Files/Providers/CorporateReimbursementPolicies/Maternity-Care-Services-Reimbursement-Policy-RP202701.pdfverified 2026-10-08	“Immediate maternal postpartum care performed on the same calendar date as delivery is included in the delivery care”
In directory 1/1 plan published	Capital Blue Cross	Capital Blue Cross. The maternity notice does not name a narrower product line	< 9/1/2026	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	Before September 1, 2026, the first prenatal visit after confirmation of pregnancy continues to use bundled codes	Bundled codes (code numbers not named in this sentence)	not provided	not provided	not provided	not provided	not provided	continue	Provided	FP-01.011 effective 09/01/2026; global-to-visit transition effective 01/01/2027	operational	not provided	not provided	D98https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-information/!ut/p/z1/jZBLDoIwEIbPwgk6La-yLAZaQqFAFbAbw8o0UXRhPL-NcaNGZHaT-f5HBhk0IjNPd3ucbvYyTye37010qFhBMA6w5IrnEOW9ppFofbUN0fAEauquTIOEDafAGqF7WRbAW4zMGj38GAbr9AuAWbYfkHmPUH3iHLoyicOuJBWBTwAocUDaiDgD4QcYfwG6zoHFOtMqlRxY-AKWnvSv5vW8241gC8s87wFgD6Wg/#section-1-sub3verified 2026-10-08	“Prior to September 1, 2026, (global-based billing) – Patients presenting for their first prenatal visit after the confirmation of pregnancy will continue to use bundled codes:”
In directory 1/1 plan published	Capital Blue Cross	Capital Blue Cross. The maternity notice does not name a narrower product line	>= 9/1/2026	Any	Initial prenatal visit	First prenatal visit after confirmation	Antepartum	On or after September 1, 2026, the first prenatal visit after confirmation of pregnancy requires an E/M code with modifier TH and ICD-10-CM Z3A.XX for weeks of gestation	E/M code	TH	ICD-10-CM Z3A.XX weeks of gestation	not provided	not provided	not provided	must	Provided	FP-01.011 effective 09/01/2026; global-to-visit transition effective 01/01/2027	operational	not provided	not provided	D98https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-information/!ut/p/z1/jZBLDoIwEIbPwgk6La-yLAZaQqFAFbAbw8o0UXRhPL-NcaNGZHaT-f5HBhk0IjNPd3ucbvYyTye37010qFhBMA6w5IrnEOW9ppFofbUN0fAEauquTIOEDafAGqF7WRbAW4zMGj38GAbr9AuAWbYfkHmPUH3iHLoyicOuJBWBTwAocUDaiDgD4QcYfwG6zoHFOtMqlRxY-AKWnvSv5vW8241gC8s87wFgD6Wg/#section-1-sub3verified 2026-10-08	“On or after September 1, 2026, (visit/service based billing) – Patients presenting for their first prenatal visit after confirmation of pregnancy will require the use of:”
In directory 1/1 plan published	Capital Blue Cross	Capital Blue Cross. The maternity notice does not name a narrower product line	>= 1/1/2027	Any	Any	Any	All	Obstetrics and maternity services transition from global-based billing to visit/service-based billing effective January 1, 2027	not provided	not provided	not provided	not provided	not provided	not provided	will	Provided	FP-01.011 effective 09/01/2026; global-to-visit transition effective 01/01/2027	operational; code list for the January 1, 2027 services is in FP-01.011 and is not restated in this notice sentence	not provided	not provided	D98https://www.capbluecross.com/wps/portal/cap/provider/news-updates/news-announcements/2026-07-001-updates-new-information/!ut/p/z1/jZBLDoIwEIbPwgk6La-yLAZaQqFAFbAbw8o0UXRhPL-NcaNGZHaT-f5HBhk0IjNPd3ucbvYyTye37010qFhBMA6w5IrnEOW9ppFofbUN0fAEauquTIOEDafAGqF7WRbAW4zMGj38GAbr9AuAWbYfkHmPUH3iHLoyicOuJBWBTwAocUDaiDgD4QcYfwG6zoHFOtMqlRxY-AKWnvSv5vW8241gC8s87wFgD6Wg/#section-1-sub3verified 2026-10-08	“Reimbursement Policy FP-01.011 also addresses the following obstetrics and maternity services transitioning from global-based billing to visit/service-based billing effective January 1, 2027 .”
In directory 1/1 plan published	Healthfirst	Child Health Plus (CHP); Essential Plan (EP); Integrated Benefit Dual Plan (IB-Dual); Medicaid Advantage Plus/MAP (CompleteCare); Medicaid Managed Care (MMC); Qualified Health Plan (QHP); Personal Wellness Plan (HARP); Medicare Advantage	>= 6/1/2026 (antepartum services initiated) and/or	>= 1/1/2027 (estimated due date)	Any	Routine prenatal	Antepartum	Bill the appropriate E/M code with modifier TH and a pregnancy-related O or Z ICD-10 diagnosis code	99202-99205, 99211-99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99417	TH	Pregnancy-related O or Z ICD-10 diagnosis code	not provided	not provided	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	operational	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“PO-RE-132v4 Obstetric Billing Guidelines Reimbursement Policy XP23_73 Page 2 of 17 Prenatal Billing Transition (Effective June 1, 2026) For routine prenatal visits for individuals who initiate antepartum services on or after June 1, 2026, and for pregnancies with an estimated due date on or after January 1, 2027, providers must bill the appropriate E/M code with modifier TH and use pregnancy-related O or Z ICD-10 diagnosis codes.”
In directory 1/1 plan published	Healthfirst	Child Health Plus (CHP); Essential Plan (EP); Integrated Benefit Dual Plan (IB-Dual); Medicaid Advantage Plus/MAP (CompleteCare); Medicaid Managed Care (MMC); Qualified Health Plan (QHP); Personal Wellness Plan (HARP); Medicare Advantage	>= 1/1/2027	Any	Any	Any	All	Do not bill the listed bundled and global CPT codes for service dates on or after January 1, 2027	not provided	not provided	not provided	not provided	59400, 59510, 59610, 59618, 59425, 59426, 59410, 59515, 59614, 59622, 59430, 59409, 59514, 59612, 59620, 59050, 59525	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	operational	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“Deleted or Unavailable Bundled and Global CPT Codes for Dates of Service on or After January 1, 2027 The following bundled and global CPT codes must not be billed for service dates on or after January 1, 2027: CPT Code Description 59400 59510 59610 Global vaginal delivery (antepartum, delivery, and postpartum care) Global cesarean delivery (antepartum, delivery, and postpartum care) Global VBAC (vaginal birth after previous cesarean) PO-RE-132v4 Obstetric Billing Guidelines Reimbursement Policy XP23_73 Page 3 of 17 59618 59425 59426 59410 59515 59614 59622 59430 59409 59514 59612 59620 59050 59525 Global cesarean delivery following attempted VBAC Antepartum care only; 4-6 visits Antepartum care only; 7 or more visits Vaginal delivery and postpartum care only Cesarean delivery and postpartum care only VBAC delivery and postpartum care only Cesarean delivery after attempted VBAC and postpartum care only Postpartum care only (separate procedure) Vaginal delivery only (without postpartum care) Cesarean delivery only (without postpartum care) VBAC delivery only (without postpartum care) Cesarean delivery only after attempted VBAC (without postpartum care) Fetal monitoring during labor by attending physician Subtotal or total hysterectomy after cesarean delivery Additional obstetric CPT coding changes become effective January 1, 2027.”
In directory 1/1 plan published	Healthfirst	Child Health Plus (CHP); Essential Plan (EP); Integrated Benefit Dual Plan (IB-Dual); Medicaid Advantage Plus/MAP (CompleteCare); Medicaid Managed Care (MMC); Qualified Health Plan (QHP); Personal Wellness Plan (HARP); Medicare Advantage	< 6/1/2026	< 1/1/2027	4-6	Antepartum care only, pregnancy not subject to the June 1, 2026 transition	Antepartum	Bill one unit of CPT 59425 for 4-6 antepartum visits	59425	not provided	not provided	not provided	not provided	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	operational	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“E/M Codes for Routine Antepartum Care (Transition Rule) For routine prenatal visits subject to June 1, 2026, transition rule, the following CPT E/M codes may be used with modifier TH, based on the setting, patient status, and level of service documented in the medical record: CPT Codes Use 99202-99205 Office or other outpatient visit codes for new patients 99211-99215 Office or other outpatient visit codes for established patients 99341, 99342, 99344, 99345 Residence visit codes for new patients 99347, 99348, 99349, 99350 Residence visit codes for established patients 99417 Prolonged outpatient service, each 15 minutes Antepartum Care Only PO-RE-132v4 Obstetric Billing Guidelines Reimbursement Policy XP23_73 Page 4 of 17 For pregnancies not subject to June 1, 2026, prenatal billing transition, if the patient is treated for antepartum services only, one antepartum care-only CPT code should be reported based on the total number of antepartum visits rendered during the pregnancy: • CPT 59425 for 4-6 visits. • CPT 59426 for 7 or more visits. • For 1-3 antepartum visits, report the appropriate E/M CPT code instead.”
In directory 1/1 plan published	Healthfirst	Child Health Plus (CHP); Essential Plan (EP); Integrated Benefit Dual Plan (IB-Dual); Medicaid Advantage Plus/MAP (CompleteCare); Medicaid Managed Care (MMC); Qualified Health Plan (QHP); Personal Wellness Plan (HARP); Medicare Advantage	< 6/1/2026	< 1/1/2027	7+	Antepartum care only, pregnancy not subject to the June 1, 2026 transition	Antepartum	Bill one unit of CPT 59426 for 7 or more antepartum visits	59426	not provided	not provided	not provided	not provided	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	operational	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“E/M Codes for Routine Antepartum Care (Transition Rule) For routine prenatal visits subject to June 1, 2026, transition rule, the following CPT E/M codes may be used with modifier TH, based on the setting, patient status, and level of service documented in the medical record: CPT Codes Use 99202-99205 Office or other outpatient visit codes for new patients 99211-99215 Office or other outpatient visit codes for established patients 99341, 99342, 99344, 99345 Residence visit codes for new patients 99347, 99348, 99349, 99350 Residence visit codes for established patients 99417 Prolonged outpatient service, each 15 minutes Antepartum Care Only PO-RE-132v4 Obstetric Billing Guidelines Reimbursement Policy XP23_73 Page 4 of 17 For pregnancies not subject to June 1, 2026, prenatal billing transition, if the patient is treated for antepartum services only, one antepartum care-only CPT code should be reported based on the total number of antepartum visits rendered during the pregnancy: • CPT 59425 for 4-6 visits. • CPT 59426 for 7 or more visits. • For 1-3 antepartum visits, report the appropriate E/M CPT code instead.”
In directory 1/1 plan published	Healthfirst	Child Health Plus (CHP); Essential Plan (EP); Integrated Benefit Dual Plan (IB-Dual); Medicaid Advantage Plus/MAP (CompleteCare); Medicaid Managed Care (MMC); Qualified Health Plan (QHP); Personal Wellness Plan (HARP); Medicare Advantage	< 6/1/2026	< 1/1/2027	1-3	Antepartum care only, pregnancy not subject to the June 1, 2026 transition	Antepartum	Report the appropriate E/M code for 1-3 antepartum visits. Do not bill 59425 or 59426	Appropriate E/M code	not provided	not provided	not provided	not provided	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	operational	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“E/M Codes for Routine Antepartum Care (Transition Rule) For routine prenatal visits subject to June 1, 2026, transition rule, the following CPT E/M codes may be used with modifier TH, based on the setting, patient status, and level of service documented in the medical record: CPT Codes Use 99202-99205 Office or other outpatient visit codes for new patients 99211-99215 Office or other outpatient visit codes for established patients 99341, 99342, 99344, 99345 Residence visit codes for new patients 99347, 99348, 99349, 99350 Residence visit codes for established patients 99417 Prolonged outpatient service, each 15 minutes Antepartum Care Only PO-RE-132v4 Obstetric Billing Guidelines Reimbursement Policy XP23_73 Page 4 of 17 For pregnancies not subject to June 1, 2026, prenatal billing transition, if the patient is treated for antepartum services only, one antepartum care-only CPT code should be reported based on the total number of antepartum visits rendered during the pregnancy: • CPT 59425 for 4-6 visits. • CPT 59426 for 7 or more visits. • For 1-3 antepartum visits, report the appropriate E/M CPT code instead.”
In directory 1/1 plan published	Healthfirst	Medicaid Managed Care (MMC); Personal Wellness Plan (HARP)	Any	Any	Any	Any	Antepartum	Continue separate informational reporting of 0500F or 0503F. These Category II codes are not reimbursed	not provided	not provided	not provided	0500F, 0503F	not provided	not provided	must	Provided	Prenatal transition 06/01/2026 for stated pregnancies; bundled and global codes unavailable 01/01/2027	informational reporting	not provided	not provided	D61https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-10-08	“MMC and HARP, continue separate informational reporting of 0500F or 0503F. Category II CPT codes (0500F, 0503F) are considered informational-only and will not be reimbursed. Applicable Codes Codes that will be deleted an”
In directory 1/1 plan published	Medicaid Connecticut	Connecticut Medical Assistance Program. Not the maternity bundle program	>= 9/1/2026	>= 1/1/2027 (delivery anticipated after December 31, 2026)	Any	Any	Antepartum	Bill each antepartum visit with the appropriate E/M procedure code and modifier TH	Appropriate E/M procedure code	TH	not provided	not provided	not provided	not provided	must	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“The billing guidance updates will happen in two phases: • Phase 1: Effective for dates of service September 1, 2026 and forward, with a delivery date anticipated after December 31, 2026, all antepartum visits must be billed with the appropriate evaluation/management (E/M) procedure code.”
In directory 1/1 plan published	Medicaid Connecticut	Connecticut Medical Assistance Program. Not the maternity bundle program	>= 9/1/2026 (starting in September 2026)	< 12/31/2026 (delivery anticipated prior to December 31, 2026)	Any	Any	Antepartum	Bill antepartum care with one of the applicable E/M codes and modifier TH	98000-98003, 98004-98013, 99202-99205, 99211-99215, 99221-99223, 99231-99233, 99234-99236, 99291-99292, 99341-99345	TH	not provided	not provided	not provided	not provided	must	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“Starting in September, antepartum care will be billed with one of the applicable E/M codes for all deliveries that are anticipated to occur prior to December 31, 2026: CPT Code Range Description 98000-98003 New patient synchronous audio-video visit 98004-98013 Established patient synchronous audio video visit 99202-99205 New patient office or other outpatient visit 99211-99215 Established patient office or other outpatient visit 99221-99223 Initial hospital care with medical decision making 99231-99233 Subsequent hospital care with medical decision making 99234-99236 Hospital inpatient or observation care 99291-99292 Critical care 99341-99345…”
In directory 1/1 plan published	Medicaid Connecticut	Connecticut Medical Assistance Program	Any	< 1/1/2027 (delivery prior to January 1, 2027)	Any	Any	Labor management / Delivery / Postpartum	Continue to bill existing procedure codes for labor, delivery, and postpartum care	Existing labor, delivery, and postpartum procedure codes	not provided	not provided	not provided	not provided	not provided	continue	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“Maternity care providers will continue to bill existing procedure codes for the actual labor and delivery and postpartum care for maternity episodes where the delivery occurs prior to January 1, 2027.”
In directory 1/1 plan published	Medicaid Connecticut	Maternity bundle program	>= 9/1/2026	Any	Any	Any	Antepartum	Continue to bill as instructed in PB 2025-66 Maternity Bundle Payment Program, Performance Year 2	not provided	not provided	not provided	not provided	not provided	not provided	should	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“Please note: For Phase 1, providers who participate in the maternity bundle program should continue to bill as instructed in PB 2025-66 “Maternity Bundle Payment Program – Performance Year 2”.”
In directory 1/1 plan published	Medicaid Connecticut	Federally Qualified Health Centers	<= 12/31/2026	Any	Any	Any	Antepartum	Continue the appropriate antepartum procedure code with T1015 through December 31, 2026	Appropriate antepartum procedure code and T1015	not provided	not provided	not provided	not provided	not provided	continue	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“FQHCs will continue to bill with the appropriate antepartum procedure code along with the T1015 Clinic visit/encounter, all inclusive procedure code through December 31, 2026.”
In directory 1/1 plan published	Medicaid Connecticut	Family planning clinics	<= 12/31/2026	Any	Any	Any	Antepartum	Continue the appropriate antepartum procedure code on the family planning clinic fee schedule through December 31, 2026	Appropriate antepartum procedure code on the family planning clinic fee schedule	not provided	not provided	not provided	not provided	not provided	continue	Provided	Provider Bulletin 2026-44, August 2026; Phase 1 effective 09/01/2026; Phase 2 effective 01/01/2027	operational	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	D89https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb26_44.pdf&URI=Bulletins%2Fpb26_44.pdfverified 2026-10-08	“Family planning clinics will continue to bill with the appropriate antepartum procedure code that is listed on the family planning clinic fee schedule through December 31, 2026.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	Any	Any	>= 4	Any	All	Bill one global obstetric code when one practitioner or the same group provides prenatal care of four or more visits, labor and delivery, and postpartum care. Report the date of delivery	59400, 59510, 59610, 59618	not provided	not provided	not provided	not provided	not provided	must	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	current global billing; September 1, 2026 memo not restated here	not provided	not provided	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“The complete global OB CPT codes are 59400, 59510, 59610, 59618.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	Any	Any	Any	Any	Delivery / Postpartum	Partial global billing for labor, delivery, and postpartum care without prenatal care of at least 4 visits: 59410 with 0503F	59410	not provided	not provided	0503F	not provided	not provided	must	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	current global billing; September 1, 2026 memo not restated here	not provided	not provided	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“59410 vaginal delivery including postpartum care with 0503F.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	Any	Any	Any	Any	Delivery / Postpartum	Partial global billing for labor, delivery, and postpartum care without prenatal care of at least 4 visits: 59515 with 0503F	59515	not provided	not provided	0503F	not provided	not provided	must	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	current global billing; September 1, 2026 memo not restated here	not provided	not provided	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“59515 cesarean including postpartum care with 0503F.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	Any	Any	Any	Any	Delivery / Postpartum	Partial global billing for labor, delivery, and postpartum care without prenatal care of at least 4 visits: 59614 with 0503F	59614	not provided	not provided	0503F	not provided	not provided	must	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	current global billing; September 1, 2026 memo not restated here	not provided	not provided	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“59614 VBAC including postpartum care with 0503F.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	Any	Any	Any	Any	Delivery / Postpartum	Partial global billing for labor, delivery, and postpartum care without prenatal care of at least 4 visits: 59622 with 0503F	59622	not provided	not provided	0503F	not provided	not provided	must	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	current global billing; September 1, 2026 memo not restated here	not provided	not provided	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“59622 C-section after attempted VBAC including postpartum care with 0503F.”
In directory 1/1 plan published	Health First Colorado	Health First Colorado	>= 9/1/2026	Any	Any	New pregnancy	Antepartum	For new pregnancies beginning on dates of service September 1, 2026 and after, reference Maternity Services Billing Operational Guidance Memo OM26-056. This manual does not restate that memo	not provided	not provided	not provided	not provided	not provided	not provided	should	Provided	Manual revision 08/25/2026. OM26-056 is referenced for pregnancies beginning 09/01/2026 and is not restated	operational-details-pending	not provided	OM26-056, effective September 1, 2026, is referenced and not restated	D78https://hcpf.colorado.gov/OB-manualverified 2026-10-08	“Prenatal Care Only: For new pregnancies beginning on dates of service 9/1/2026 and beyond: Providers should reference the Maternity Services Billing Operational Guidance Memo (OM26-056), which can be found on the Department's Memo Series web page under 2026 memos.”

Payer contacts and promised follow-up guidance

Verbatim from each source; “not provided” when the document names no provider-facing contact or no follow-up date.

Source	Payer	Payer contact	Further guidance promised	Source wording
D02	Aetna	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	“Stay tuned for future communications as additional coding, valuation, reimbursement and fee schedule information becomes available.”
D03	Aetna Better Health of Florida	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	“Additional coding guidance and claims-editing rules are expected but were not yet finalized at the time of early release.”
D04	Cigna Healthcare	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	“We will continue to monitor industry developments and provide additional 2027 billing guidance later this year.”
D05	NC Medicaid (NCDHHS)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	“Clinical Coverage 1E-5 is being revised to reflect the updated information.”
D06	Michigan Medicaid (MDHHS)	not provided	September 2026 - policy bulletin for public comment	“A policy bulletin will be published for public comment in September reflecting coding updates for routine maternity care services furnished on and after January 1, 2027.”
D07	NYS Medicaid (DOH)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	“Further guidance will be released by the AMA for obstetric-related services, and the NYS Department of Health will release further Medicaid Update articles.”
D09	MaineCare (Maine DHHS OMS)	Provider Relations Specialist (no number in notice); Maine DHHS (207) 287-3707	not provided	—
D10	Anthem Blue Cross and Blue Shield (New York)	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	“Providers should refer to NYS Medicaid Update - April 2026 Volume 42 - Number 5 for additional billing guidance.”
D11	Arkansas Blue Cross and Blue Shield	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	“Arkansas Blue Cross will provide further guidance on recommended billing practices for initial prenatal visits for confirmation of pregnancy that occur on or after September 1, 2026.”
D12	TennCare (Tennessee Medicaid)	contracted MCO's provider relations team	not provided	—
D13	MassHealth	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	“MassHealth plans to provide additional billing guidance in 2027 for the AMA 2027 Maternity Services Coding Structure.”
D17	Blue Cross NC	not provided	'coming months' (from 2026-04); billing changes begin mid-May 2026	“Additional guidance and resources will be shared in the coming months.”
D18	Washington Apple Health (HCA)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	“HCA will publish guidance for clients whose pregnancy care spans 2026 and 2027.”
D20	BlueCross BlueShield of Tennessee	Provider Network Manager (generic BlueAlert footer)	not provided	—
D21	CareFirst BlueCross BlueShield	gender.services@carefirst.com is the only contact in the chapter (unrelated program)	not provided	—
D22	Community First Health Plans (TX)	Provider Relations ProviderRelations@cfhp.com, 210-358-6030	No date - 'as more information becomes available'	“Community First is currently reviewing these revisions and will provide additional guidance as more information becomes available.”
D23	Highmark (Highmark BS CPA/SEPA, BCBS DE, BS NENY, BCBS WNY, BCBS WPA/NEPA, BCBS WV)	not provided	No date - 'will formally notify you of any changes'	“We will formally notify you of any changes that may affect your claim submissions for Highmark members.”
D24	Geisinger Health Plan	Claims: 844-GHP-PROV (844-447-7768)	No date - operational details, billing guidance, educational resources 'as implementation planning continues'	“Additional communications will be shared as implementation planning continues, including operational details, billing guidance, and educational resources.”
D25	Healthfirst (New York)	not provided (refers to provider contract)	not provided	—
D26	Highmark Blue Cross Blue Shield of Western New York	Provider Services 1-866-231-0847	not provided	—
D29	Independent Health (NY)	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	“will have a section dedicated to this change within the Participating Provider Reimbursement Manual on your provider portal as of June 1, 2026”
D30	Kaiser Permanente Northern California	Medical Services Contracting (925) 924-5050	not provided	—
D32	NYS Medicaid (DOH)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	“Further guidance will be released by the AMA for obstetric-related services, and the NYS Department of Health will release further Medicaid Update articles.”
D33	CMS Medicare (Physician Fee Schedule) - all Part B MACs	MedicarePhysicianFeeSchedule@cms.hhs.gov; claims questions to the Medicare Administrative Contractor	Comment period ends 2026-09-14; CY 2027 PFS final rule (CMS-1848-P) to follow	“This document has a comment period that ends in 9 days. (09/14/2026)”
D34	Molina Healthcare of Florida	Provider Relations Representative or Provider Services (855) 322-4076	not provided	—
D35	Oscar Health	Member Care Team 1-855-672-2755 (member line, not provider)	not provided	—
D48	Florida Blue / Truli for Health	not provided	Additional policy forthcoming	“The full 2027 policy is coming.”
D52	Sentara Health Plans	not provided	Additional Sentara resources forthcoming	“Additional Sentara resources are forthcoming.”
D55	Horizon Blue Cross Blue Shield of New Jersey	Assigned Provider Account Specialist	not provided	—
D78	Health First Colorado	not provided	OM26-056, effective September 1, 2026, is referenced and not restated	“Exceptions to Global or Partial Global Billing Guidelines include: member transfers into or out of a physician or affiliated group and services do not meet complete global or partial global criteria; referral to another non-group physician; delivery by another physician not associated with the regular physician; termination or miscarriage; member changes insurers; the member's pregnancy meets circumstances outlined in the Maternity Services Billing Operational Guidance Memo (OM26-056) effective September 1, 2026.”
D87	BCBS North Dakota	not provided	December	“Watch for final guidance and education materials in December”
D89	Medicaid Connecticut	not provided	Phase 2: new labor management and delivery procedure codes will be added to fee schedules effective January 1, 2027. The bulletin does not list those codes.	“• Phase 2: Effective for dates of service January 1, 2027 and forward, new procedure codes for labor management and delivery care will be added to appliable fee schedules.”

Evidence standard

How rows are produced

Rows are extracted document by document. A row is only linked to a plan when the document names that payer, program or product; the plans column is then resolved against the live policy directory, so plans the directory review removed or re-labelled are shown accordingly.

Guidance is “Provided” when the document states an operational billing instruction, “Provided (by reference)” when it defers to another named document, and “Not provided” or “Inferred” otherwise. Obligation preserves the payer's verb (must, should, may, encouraged).

Research note: This resource is operational policy intelligence, not legal, medical, or coding advice. Verify the member's exact payer, plan, state, line of business and date of service against the linked source before submitting claims.