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NC Medicaid - NCDHHSMedicaid · Billing Codes · Provider Bulletin · NC · OB-GYN, Family Medicine, General PracticeHigh impact

Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027

Act
by Sep 1, 2026
Effective date
Jan 1, 2027
Identified
Jul 11, 2026

Summary

NC Medicaid is transitioning to new AMA maternity CPT codes effective January 1, 2027. Starting September 1, 2026, providers must begin using E/M codes (99202-99215) with the TH modifier for prenatal/postpartum care when delivery is anticipated after 1/1/2027. All current maternity codes including global bundles will be deleted on 1/1/2027. Current codes may be used through 12/31/2026 for pregnancies completing before that date.

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What to do

by Sep 1, 2026 · 6 steps
01Billing team must update billing software and encounter forms to support E/M codes (99202-99215) with TH modifier for maternity cases.
02Providers must begin documenting weeks of gestation with appropriate ICD-10-CM codes and ensure medical decision making or time supports CPT level billed.
03Update billing logic to allow current maternity codes (59425, 59426) through 12/31/2026, but transition to E/M + TH modifier for all cases where delivery/postpartum visit occurs after 1/1/2027.
04Before January 1, 2027: Verify billing system will no longer accept current maternity codes on claims for service dates 1/1/2027 forward.
05Train clinical staff on new documentation requirements.
06Contact NC Medicaid at 888-245-0179 with implementation questions.
If missed: Failure to transition appropriately will result in claim denials for maternity services after 1/1/2027.

Codes mentioned

99202992039920499205992069920799208992099921099211992129921399214992155942559426

Original notice

Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027
medicaid.ncdhhs.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

NC Medicaid - NCDHHS policiesNC policy changesOB-GYNFamily MedicineGeneral PracticeCode 99202Code 99203Code 99204Code 99205Code 99206Code 99207Code 99208Code 99209Code 99210Code 99211Code 99212Code 99213Code 99214Code 99215Code 59425Code 59426

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