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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
Oct 19, 2026

Summary

Point32Health is implementing significant maternity care coding changes effective January 1, 2027, transitioning from bundled global billing codes (59425, 59426) to granular per-encounter E/M codes. The four-phase CPT 2027 maternity framework (antepartum, labor management, delivery, postpartum) replaces the current structure. Antepartum care delivered in 2026 must continue using current codes (59425, 59426, or E/M codes based on visit count), but all maternity services on or after January 1, 2027 must use the new per-encounter coding structure.

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What to do

Action · 6 steps
01Before January 1, 2027: Billing team must update billing software and train staff on the new maternity coding framework.
02Verify current 2026 antepartum coding continues using CPT 59425 (4-6 visits), CPT 59426 (7+ visits), or E/M codes (fewer than 4 visits) as applicable based on visit count.
03Prepare for deletion of CPT codes 59425 and 59426 effective January 1, 2027.
04Configure billing system to report all antepartum visits on or after January 1, 2027 per individual encounter using the appropriate E/M code based on patient location.
05Implement the new four-phase maternity coding structure (antepartum, labor management, delivery, postpartum) per Point32Health's updated Obstetrics/Gynecology Payment Policy.
06Providers and billing staff should review the updated policy immediately to understand the transition.
If missed: Failure to implement the new coding structure on January 1, 2027 will result in claim denials for maternity services billed under obsolete codes.

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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