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Medi-CalMedicaid · Billing Codes · Provider Bulletin · CA · OB-GYNHigh impact

Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH

Act
by Nov 1, 2026
Effective date
Nov 1, 2026
Identified
Sep 19, 2026

Summary

Effective November 1, 2026, Medi-Cal encourages obstetrical providers to bill prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change aligns with upcoming AMA coding framework changes (effective January 1, 2027) that separately identify antepartum, labor, delivery, and postpartum services. Prenatal claims must include gestational age codes (Z3A.00-Z3A.49); postpartum claims must include relevant postpartum diagnosis codes (O86-O92, Z39.0-Z39.2, or F53.0-F53.1).

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What to do

by Nov 1, 2026 · 9 steps
01Billing team must update billing software and encounter forms to support E&M code billing with modifier TH for obstetrical prenatal and postpartum visits.
02Providers must be trained to.
03Select E&M codes (99204, 99205, 99213, 99214, 99215) based on time and complexity.
04Always append modifier TH to these codes.
05Include gestational age ICD-10 codes (Z3A.00-Z3A.49) on all prenatal claims.
06Include postpartum diagnosis codes (O86-O92, Z39.0-Z39.2, or F53.0-F53.1) on all postpartum claims.
07Update claim submission templates and billing rules.
08CPSP providers and doulas must continue using local Z codes (Z1032, Z1034, Z1038) until further notice.
09Claims submitted without modifier TH or required diagnosis codes will be subject to denial or rework by Medi-Cal.

Codes mentioned

9920499205992139921499215Z1032Z1034Z1038O86O87O88O89O90O91O92Z39.0Z39.1Z39.2F53.0F53.1

Original notice

Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Medi-Cal changes →
Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier THHighEffective Nov 1, 2026 · Provider BulletinBrowse every Medi-Cal change in the policy list

Related policy hubs

Medi-Cal policiesCA policy changesOB-GYNCode 99204Code 99205Code 99213Code 99214Code 99215Code Z1032Code Z1034Code Z1038Code O86Code O87Code O88Code O89Code O90Code O91Code O92Code Z39.0Code Z39.1Code Z39.2Code F53.0Code F53.1

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