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Harvard Pilgrim Health CareAll Plans · Billing Codes · Reimbursement · OB-GYNHigh impact

Changes to maternity care coding coming Jan. 1, 2027

Effective date
Jan 1, 2027
Identified
Aug 17, 2026

Summary

Point32Health is restructuring maternity care CPT coding effective January 1, 2027, replacing bundled global codes with granular service-level codes organized into four phases (antepartum, labor management, delivery, postpartum). Immediately effective August 1, 2026, antepartum visits must be coded differently based on visit count: CPT 59425 (4-6 visits), CPT 59426 (7+ visits), or E/M codes (fewer than 4 visits). All antepartum codes will be deleted in 2027 and replaced with per-encounter E/M codes.

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What to do

Action · 11 steps
01IMMEDIATE 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.
02For 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.
03Audit existing OB encounter forms and workflow to track visit counts accurately.
04Train all front desk, clinical, and billing staff on new coding requirements.
05PHASE 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.
06Work with Point32Health and providers to establish new E/M code mappings.
07Update billing software billing rules and encounter templates.
08Notify providers of transition.
09Hold staff training on new 2027 E/M-based antepartum coding.
10Failure to implement coding changes will result in claim denials and compliance violations.
11Monitor Point32Health communications for labor management, delivery, and postpartum coding guidance expected in future updates.

Codes mentioned

5942559426

Original notice

Changes to maternity care coding coming Jan. 1, 2027
point32health.org · Always check the source before changing claims.
View original ↗

Related changes

See all Harvard Pilgrim Health Care changes →
Changes to maternity care coding coming Jan. 1, 2027HighEffective Jan 1, 2027 · ReimbursementBrowse every Harvard Pilgrim Health Care change in the policy list

Related policy hubs

Harvard Pilgrim Health Care policiesOB-GYNCode 59425Code 59426

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