All PlansBilling CodesHigh impact
Prenatal Care and New Obstetric Billing Codes Seminar
Blue Cross Blue Shield of Vermont·VT · OB-GYN·Provider News
Effective date
Sep 1, 2026
We identified it
Sep 5, 2026
Summary
Blue Cross VT is transitioning obstetric billing from global codes (59425, 59426) to new unbundled maternity services codes effective 2027. Beginning September 1, 2026, prenatal care must be billed using E/M codes with modifier -TH and Z34A ICD-10 codes for gestation confirmation. A mandatory webinar on September 16, 2026, will cover implementation details, clinical guidance, and workflow changes required for this significant coding transition.
Action Required
IMMEDIATE ACTIONS REQUIRED: (1) By September 16, 2026: Billing team, coders, and providers must attend the mandatory webinar 'Implementing Tailored Prenatal Care and New Obstetric Billing Codes' on September 16, 2026 at 2:00 p.m. ET to understand new requirements. (2) By September 1, 2026: Providers must update documentation practices to capture medical decision making (MDM) and time-based E/M coding for all prenatal visits, as current global package documentation standards no longer apply. (3) Effective September 1, 2026: For first prenatal visits after pregnancy confirmation, billing team must: (a) Replace global codes 59425 and 59426 with appropriate E/M codes appended with modifier -TH, and (b) Require ICD-10-CM code Z34A with 4th character for gestation specificity on all prenatal claims. (4) Update billing system and encounter templates to enforce modifier -TH requirement and Z34A code selection before September 1, 2026. (5) Review and implement AMA CPT 2027 Maternity Care Services Code Changes, Guidelines, and FAQs (provided in policy) across all prenatal workflows. CONSEQUENCES: Claims submitted without modifier -TH or without appropriate Z34A codes will be denied. Providers must ensure documentation supports E/M coding per current CPT guidelines or claims will be rejected.