CommercialBilling CodesHigh impact
Changes to maternity billing requirements to start Oct. 9, 2026
BCBS Michigan·MI · OB-GYN·Claims & Billing
Effective date
Oct 9, 2026
We identified it
Jul 23, 2026
Summary
Blue Cross Blue Shield of Michigan is implementing interim maternity billing requirement changes effective Oct. 9, 2026, to prepare for the AMA's transition from global bundled prenatal codes to individual E/M codes on Jan. 1, 2027. Starting Oct. 9, 2026, patients with their first prenatal visit on or after that date must be billed using E/M codes (unless they have 4+ visits in 2026), and the TH modifier will become required for all prenatal E/M claims. Practices must update billing workflows to track first visit dates and apply appropriate coding rules by plan member delivery date.
Action Required
By Oct. 9, 2026: Billing team must implement system changes to distinguish maternity patients by first prenatal visit date (on/before Oct. 8 vs. on/after Oct. 9). For patients with first visit on or after Oct. 9, 2026, update billing software to require E/M codes instead of bundled prenatal codes, EXCEPT when patient has 4+ visits with same provider group in 2026 (then continue bundled codes). For all patients presenting on/after Oct. 9, the TH modifier will be required on all prenatal E/M claims. Update encounter forms and billing rules to track visit count per provider group in 2026. Modify patient intake/scheduling workflows to flag delivery dates on/after Jan. 1, 2027 to trigger new billing requirements. Failure to implement these changes will result in claim denials on prenatal services for affected members. Before Jan. 1, 2027: Providers and billing staff must be prepared for additional modifier requirements that will be communicated by BCBSM in coming months.