[New York] 2027 maternity care coding restructuring allows for more detailed reporting

By December 31, 2026: Billing team must complete the following preparation tasks: (1) Obtain and review the CPT® 2027 maternity care codes released early by the AMA and the approved guidelines from the policy source; (2) Update billing software to reflect the new four-phase maternity coding structure, replacing all legacy global maternity codes; (3) Reprogram system edits to require separate billing for antepartum E/M codes per encounter (with site of service modifiers for office/hospital/telehealth), labor management codes with initial/subsequent day differentiation and complexity levels, delivery codes specific to delivery type (vaginal with/without episiotomy, VBAC, primary/repeat cesarean, plus new third/fourth-degree laceration repair and hysterectomy codes), and postpartum E/M codes per encounter (excluding routine postpartum on delivery day); (4) Providers must audit and update clinical documentation templates to capture required data for E/M coding intensity (antepartum and postpartum visits) and complexity levels for labor management; (5) Train billing and clinical staff on the new structure, emphasizing that patients initiating prenatal care on or after June 1, 2026, and/or with estimated due dates on or after January 1, 2027, must use restructured codes; (6) Reference NYS Medicaid Update – April 2026 Volume 42 – Number 5 for additional billing guidance. Beginning January 1, 2027: Verify all maternity claims submitted to NYS Medicaid use restructured coding only; claims using legacy global codes will likely be denied. Contact Anthem Provider Services at 800-450-8753 with questions.