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MMP 26-46: Updates to Coverage of Maternity Care Services
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 31, 2026
Summary
Effective January 1, 2027, Michigan Medicaid transitions from global maternity CPT codes (59400, 59510, 59620, 59425, 59426, 59430) to separate encounter-based E/M and obstetric procedure codes. Providers must append modifier TH and appropriate ICD-10-CM diagnosis codes to routine antepartum and postpartum E/M claims to qualify for enhanced reimbursement. Claims submitted with global codes on/after January 1, 2027 will only be paid if all service dates occurred by December 31, 2026.
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What to do
by Dec 31, 2026 · 9 steps
01Billing team must transition maternity care billing from global CPT codes to separate E/M and obstetric procedure codes in the billing system.
02Beginning January 1, 2027.
03Update encounter documentation templates to capture appropriate E/M levels and obstetric procedures separately.
04Modify claim submission workflows to require modifier TH appended to routine antepartum and postpartum E/M codes.
05Ensure all routine maternity claims include appropriate ICD-10-CM obstetric diagnosis codes (Z3A codes for weeks of gestation as applicable).
06Verify that billing software enforces the enhanced reimbursement thresholds (up to 13 antepartum visits, up to 2 postpartum visits per pregnancy) and flags additional medically necessary visits for standard physician services reimbursement rates.
07For FQHCs/RHCs/THCs/Tribal FQHCs: confirm clinic setting services are billed on institutional forms with PPS/AIR methodology and non-clinic (hospital) labor/delivery services are billed on professional CMS 1500/837P forms with FFS methodology.
08Verify Medicaid Health Plan coverage requirements for enrolled beneficiaries.
09Consequence: Claims submitted with global maternity codes on/after January 1, 2027 will be denied unless all dates of service occurred on or before December 31, 2026.
Codes mentioned
594005951059620594255942659430
Original notice
MMP 26-46: Updates to Coverage of Maternity Care Services
michigan.gov · Always check the source before changing claims.