MedicaidBilling CodesHigh impact
Changes to Maternity Care CPT Codes for 2027
Alabama Medicaid·AL · OB-GYN·Claims & Billing
Effective date
Jan 1, 2027
We identified it
Oct 2, 2026
Summary
Alabama Medicaid is retiring global maternity care CPT codes effective January 1, 2027, and replacing them with new AMA-established codes. Providers must use existing global codes for services delivered in 2026 and new maternity codes (with TH modifier) for services on or after January 1, 2027. For split-year cases where prenatal care occurs in 2026 but delivery is in 2027, billing will use two different code sets based on service date.
Action Required
By December 31, 2026: Billing team must implement system changes to support dual code sets for maternity services. (1) Update billing software to recognize service dates and automatically route 2026 maternity services to legacy global CPT codes (59425, 59426, E/M codes based on antepartum visit count) and 2027+ services to new maternity CPT codes with TH modifier appended. (2) Providers and front desk staff must ensure all maternity encounter dates are accurately captured in the system to enable correct code selection. (3) For split-year cases (prenatal in 2026, delivery in 2027), configure system to bill antepartum services separately using legacy codes and delivery/postpartum services using new codes—do NOT combine into single global code. (4) Train billing and clinical staff on the new modifier requirement (TH) for all maternity services rendered January 1, 2027 onward. (5) Update internal billing guides and encounter forms to reflect the transition. Failure to implement these changes will result in claim denials for services billed with incorrect codes or missing modifiers after January 1, 2027. Contact Gainwell Provider Assistance at (800) 688-7989 for billing support or maternitycare@medicaid.alabama.gov for maternity policy questions.