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Anthem BCBSMedicaid · Billing Codes · Coding · NY · OB-GYNHigh impact

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

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Jun 2, 2026

Summary

Effective January 1, 2027, New York Medicaid is restructuring maternity care coding from legacy global codes to granular phase-based reporting across four phases: antepartum (E/M codes per encounter), labor management (daily reporting with initial/subsequent day levels), delivery (streamlined codes by type with new laceration/episiotomy codes), and postpartum (E/M codes per encounter). This requires significant billing workflow changes for all providers billing maternity services to NYS Medicaid members.

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What to do

by Dec 31, 2026 · 9 steps
01Billing team must complete the following preparation tasks.
02Obtain and review the CPT® 2027 maternity care codes released early by the AMA and the approved guidelines from the policy source.
03Update billing software to reflect the new four-phase maternity coding structure, replacing all legacy global maternity codes.
04Reprogram 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).
05Providers 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.
06Train 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.
07Reference NYS Medicaid Update – April 2026 Volume 42 – Number 5 for additional billing guidance.
08Beginning January 1, 2027: Verify all maternity claims submitted to NYS Medicaid use restructured coding only; claims using legacy global codes will likely be denied.
09Contact Anthem Provider Services at 800-450-8753 with questions.

Original notice

[New York] 2027 maternity care coding restructuring allows for more detailed reporting
providernews.anthem.com · Always check the source before changing claims.
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