← Back to list
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027
Act
by Jan 1, 2027 (for service dates on or after that date)
Effective date
Jan 1, 2027
Identified
Oct 27, 2026
Summary
Healthfirst is moving obstetric billing from the historical global obstetrical payment model to a service-level, encounter-based framework. Beginning June 1, 2026, routine prenatal visits for certain pregnancies must be reported separately using the appropriate E/M code with modifier TH. Starting January 1, 2027, global obstetrical package codes will no longer be recognized for reimbursement.
Get alerts when payers change rules like this one
We check Healthfirst and other payers every day and email you when a change matches your specialty and state.
Get Healthfirst alertsPolicy Monitoring is free. No card required.
What to do
by Jan 1, 2027 (for service dates on or after that date) · 10 steps
01Do not bill the deleted global and bundled obstetric codes 59400, 59510, 59610, 59618, 59425, 59426, 59410, 59515, 59614, 59622, 59430, 59409, 59514, 59612, 59620, 59050 and 59525.
02Antepartum and postpartum services must be reported using E/M codes.
03Labor management may be reported separately with codes 59080, 59081, 59082 and 59083 when it is medically necessary and documented.
04Already effective June 1, 2026: For routine prenatal visits in pregnancies subject to the transition (prenatal care initiated on or after June 1, 2026, or an estimated due date on or after January 1, 2027), report each separately billed visit with the appropriate E/M code and modifier TH, and report pregnancy-related O or Z ICD-10 diagnosis codes in the appropriate claim positions.
05Modifier TH is required on each separately billed routine prenatal E/M service line.
06For pregnancies not subject to the transition, bill CPT 59425 for 4 to 6 antepartum visits or CPT 59426 for 7 or more, with one unit and the date of the last antepartum visit; report 1 to 3 visits with E/M codes.
07Deliveries require modifier U7 (less than 39 weeks, for medical necessity), U8 (less than 39 weeks, electively) or U9 (39 weeks or greater) as appropriate, and claims without the required modifier will be denied.
08Healthfirst will no longer accept claims that include modifier P.
09For MMC and HARP members, report 0500F for the initial prenatal visit and 0503F for the postpartum visit, which may be reported on the same claim as the E/M visit.
10Claims that do not follow these requirements may be denied or rejected.
Codes mentioned
5905059400594095941059425594265943059510595145951559525596105961259614596185962059622590515908059081590825908359300594125941459431594325943359434595025950359504596235989859899992029920399204992059921199212992139921499215993419934299344993459934799348993499935099417
Original notice
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027
hfproviders.org · Always check the source before changing claims.
Related changes
See all Healthfirst changes →Related policy hubs
Healthfirst policiesNY policy changesOB-GYNCode 59050Code 59400Code 59409Code 59410Code 59425Code 59426Code 59430Code 59510Code 59514Code 59515Code 59525Code 59610Code 59612Code 59614Code 59618Code 59620Code 59622Code 59051Code 59080Code 59081Code 59082Code 59083Code 59300Code 59412Code 59414Code 59431Code 59432Code 59433Code 59434Code 59502Code 59503Code 59504Code 59623Code 59898Code 59899Code 99202Code 99203Code 99204Code 99205Code 99211Code 99212Code 99213Code 99214Code 99215Code 99341Code 99342Code 99344Code 99345Code 99347Code 99348Code 99349Code 99350Code 99417