MedicaidBilling CodesHigh impact
Transition to American Medical Association Maternity Current Procedural Terminology 2027 Code Changes Effective Jan. 1, 2027
NC Medicaid - NCDHHS·NC · OB-GYN, Family Medicine, General Practice·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
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.
Action Required
By September 1, 2026: Billing team must update billing software and encounter forms to support E/M codes (99202-99215) with TH modifier for maternity cases. Providers must begin documenting weeks of gestation with appropriate ICD-10-CM codes and ensure medical decision making or time supports CPT level billed. Update 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. Before January 1, 2027: Verify billing system will no longer accept current maternity codes on claims for service dates 1/1/2027 forward. Train clinical staff on new documentation requirements. Contact NC Medicaid at 888-245-0179 with implementation questions. Failure to transition appropriately will result in claim denials for maternity services after 1/1/2027.