Changes to maternity care coding coming Jan. 1, 2027

IMMEDIATE ACTION REQUIRED - Two phases: PHASE 1 (By August 1, 2026): Billing team must update billing system to implement new antepartum visit coding for dates of service on or after August 1, 2026. For calendar year 2026, code antepartum visits as: CPT 59425 if patient receives 4-6 visits total, CPT 59426 if patient receives 7 or more visits total, or appropriate E/M codes if fewer than 4 visits. Audit existing OB encounter forms and workflow to track visit counts accurately. Train all front desk, clinical, and billing staff on new coding requirements. PHASE 2 (By December 31, 2026): Billing team must prepare for January 1, 2027 implementation by removing CPT 59425 and 59426 from billing system and configuring per-encounter E/M code reporting based on patient location. Work with Point32Health and providers to establish new E/M code mappings. Update billing software billing rules and encounter templates. Notify providers of transition. Hold staff training on new 2027 E/M-based antepartum coding. Failure to implement coding changes will result in claim denials and compliance violations. Monitor Point32Health communications for labor management, delivery, and postpartum coding guidance expected in future updates.