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

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

Act
by Nov 1, 2026
Effective date
Nov 1, 2026
Identified
Oct 10, 2026

Summary

Effective November 1, 2026, Medi-Cal encourages obstetrical providers to submit claims for prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change anticipates the AMA's January 1, 2027 replacement of the global obstetric CPT code structure, allowing separate identification of antepartum, labor, delivery, and postpartum services. Claims must include appropriate gestational age ICD-10 codes (Z3A.00-49 for prenatal) or postpartum codes (O86-O92, Z39.0-2, F53.0-1).

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What to do

by Nov 1, 2026 · 7 steps
01Billing team must implement the following changes for Medi-Cal obstetrical claims.
02Update billing software to recognize and require modifier TH when submitting E&M codes (99204, 99205, 99213, 99214, 99215) for prenatal and postpartum care services.
03Configure system to mandate inclusion of gestational age ICD-10 codes (Z3A.00-Z3A.49) for prenatal visits and relevant postpartum diagnosis codes (O86-O92, Z39.0-Z39.2, or F53.0-F53.1).
04Train billing staff and providers on the new coding framework, emphasizing that E&M code selection must be based on time and complexity.
05Note that Comprehensive Perinatal Services Program (CPSP) providers and doulas must continue using local Z codes (Z1032, Z1034, Z1038) until further notice and should not transition to E&M codes with modifier TH.
06Retain current global obstetric code processes until the January 1, 2027 AMA transition takes effect, at which point similar changes by CMS are anticipated.
07Consult the updated provider manual sections (to be released in future Medi-Cal Update) for additional requirements.

Codes mentioned

9920499205992139921499215Z1032Z1034Z1038O86O92Z39.0Z39.2F53.0F53.1

Original notice

Reminder: 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 →
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 O92Code Z39.0Code Z39.2Code F53.0Code F53.1

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