What insurance policy changes affect OB-GYN providers?

OB-GYN providers face policy updates from major payers including prior authorization requirements, billing code changes, reimbursement rate adjustments, and coverage criteria revisions. PolicyChanges.app tracks these updates daily across all major insurers.

How often do insurance policies change for OB-GYN?

Insurance payers publish policy changes on rolling schedules: some quarterly, some monthly, and some with immediate effect. OB-GYN practices typically see dozens of relevant changes per year across their contracted payers.

How do I get notified of new OB-GYN policy changes?

Sign up for a free PolicyChanges.app account and create a saved search filtered to OB-GYN. You will get an email when new policy changes match your specialty filter: daily or weekly, your choice, on every plan.

Which payers post the most policy changes affecting OB-GYN?

Based on tracked changes, OB-GYN updates have come from payers including Aetna, Michigan Medicaid - MDHHS, UnitedHealthcare, BCBS Tennessee.

PAYER POLICY CHANGES

OB-GYN Insurance Policy Changes

Keeping up with insurance policy changes that affect OB-GYN practices is a full-time job. This page aggregates the latest payer updates (prior authorization rule changes, reimbursement adjustments, billing code additions and removals, and coverage policy revisions) across all major insurers. Changes are identified and summarized daily so OB-GYN providers and their billing teams can act before deadlines pass.

Aetna · Effective Nov 14, 2026High impact
OfficeLink Updates - August 2026 notices and reminders (PDF)
Aetna precertification applies to Ranluspec, Tregzi and Decnupaz effective August 1, 2026, and to Sarclisa Escena and Revtorpyk effective September 1, 2026. Effective November 1, 2026, CPT 77436 (SGRT) is limited to one reimbursement for the entire course of treatment, and Site of Care precertification applies to commercial Oziltus (Q5165); beginning November 14, 2026, professional claims for CPT 90963 to 90966 with an inappropriate place of service may result in claim denial. New Claim and Code Review Program edits may appear beginning November 23, 2026, and global maternity codes are retired beginning January 1, 2027.
Michigan Medicaid - MDHHS · Effective Dec 1, 2026High impact
MMP 26-47: Maternal Infant Health Program Rate Increase and Update to Care Coordination Requirements
Effective December 1, 2026, Michigan Medicaid will increase reimbursement rates for Maternal Infant Health Program (MIHP) services (HCPCS codes H1000, H2000, T1023, T2022) and update care coordination requirements. The minimum time threshold for billable care coordination services increases from 30 minutes to 60 minutes per calendar month, and documentation must now include start/end times and detailed activity descriptions signed by an LSW or RN.
UnitedHealthcare · Effective Dec 1, 2026High impact
Breast Imaging for Screening and Diagnosing Cancer (for Kentucky Only)
UnitedHealthcare Community Plan of Kentucky (Medicaid) revised its breast imaging policy effective December 1, 2026, clarifying coverage criteria for MRI breast screening in high-risk individuals while designating several advanced imaging modalities (including Molecular Breast Imaging for routine screening and Positron Emission Mammography) as unproven and not medically necessary. The policy removed the standalone BSGI definition and refined language around MRI indications, genetic risk criteria, and age thresholds for screening initiation.
UnitedHealthcare · Effective Dec 1, 2026High impact
Breast Imaging for Screening and Diagnosing Cancer
UnitedHealthcare Community Plan (Medicaid) revised its breast imaging policy effective December 1, 2026, narrowing coverage criteria for advanced imaging (MRI, molecular breast imaging, CT) by clarifying genetic risk factors, dense breast tissue categories, and family history requirements. The policy tightened language around unproven modalities and removed certain imaging technologies from coverage consideration, requiring billing teams to validate medical necessity against specific genetic mutations, risk percentages, and age thresholds before claims submission.
BCBS Tennessee · Effective Dec 1, 2026High impact
Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)
BlueCross BlueShield of Tennessee is establishing a new medical policy for Leuprolide Acetate Depot (Lupron Depot and Lutrate Depot) covering four FDA-approved indications: advanced prostate cancer, ovarian cancer (malignant sex cord-stromal tumors), breast cancer (premenopausal with hormone-receptor positive status), and gender dysphoria. All covered uses require prior authorization with specific approval criteria, and the policy includes detailed requirements for gender dysphoria treatment involving age restrictions, provider specialization, and documented informed consent. This policy will supersede any existing guidance effective December 1, 2026.
Aetna · Effective Dec 1, 2026High impact
OfficeLink Updates - September 2026 newsletter
Aetna's September 2026 newsletter announces multiple billing and operational changes affecting Aetna members across commercial and Medicare plans. Key changes include new claim edits effective December 1, 2026 via the Claim and Code Review Program (CCRP), restructured maternity care coding effective January 1, 2027, updated pharmacy drug lists effective January 1, 2027, and a push toward digital prior authorization integrated into EHR workflows. Practices must update provider directory information and review state-specific policies.
Blue Cross Blue Shield of Vermont · Effective Dec 1, 2026High impact
Preventive Care Reminder Sent to Members
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
Ambetter · Effective Dec 5, 2026High impact
October 2026 Provider Newsletter
Ambetter of North Carolina's October 2026 provider newsletter, dated 10/22/26, announces that beginning 12/05/26 Evolent will guide ordering providers to select a preferred site of care when they request authorization for shoulder, hip, knee and spine surgeries. The newsletter also says claims from Critical Access Hospitals with an incorrect Type of Bill will be denied and require correction and resubmission, that claims with surrogacy diagnosis codes Z33.3 or Z31.7 trigger an automatic one-year member review, and that Ambetter payments are moving to Zelis, with Medicare, Medicaid, and Ambetter programs moving in early 2027.
Ambetter · Effective Dec 20, 2026High impact
New and Updated Clinical Payment Policies: December 20th, 2026 (PDF)
Home State Health Plan implemented seven clinical payment policy changes effective December 20, 2026, affecting behavioral health documentation requirements, burn surgery coverage, fetal surgery criteria, epidural injection frequency limits, therapy services language requirements, genetic testing, and gender-affirming procedures. The most operationally significant change is the Behavioral Health Treatment Documentation Requirements policy (HIM.CP.BH.500/CP.MP.500), which adds nine new documentation elements and modifies existing requirements for mental health claims. Billing teams must immediately review affected policies, update documentation templates and prior authorization workflows, and communicate requirements to providers.
Medi-Cal · Effective Jan 1, 2027High impact
FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status move from Medi-Cal managed care plans to Medi-Cal fee-for-service, so FQHC and RHC claims for these members must go directly to the Medi-Cal fiscal intermediary rather than to the former plan. Effective for services on or after January 1, 2027, claims sent to the former plan or to the FI for an MCP differential (wrap) rate will be denied, and from July 1, 2027, emergency and pregnancy-related services for these members are reimbursed only at the PPS rate with the appropriate diagnosis code and emergency indicator.
UnitedHealthcare · Effective Jan 1, 2027High impact
Omnibus Codes
UMR revised its medical policy bulletin for November 2026, adding unproven/not medically necessary language for several services (including photobiomodulation for AMD, CRISPR-based TB plasma testing, Alzheimer's proprietary biomarker and genetic tests, and digital 3D models from surface mesh files) and revising criteria for IRE ablation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, histotripsy, external urine management systems, sacral Tarlov cyst surgery (now requiring failure of conservative multidisciplinary management instead of 12 weeks of non-surgical treatment), and meibomian gland procedures. The bulletin's status is revised with an effective date of 2027-01-01 for these coverage guidelines.
HealthPartners · Effective Jan 1, 2027High impact
Fast Facts Newsletter - November 2026
HealthPartners' November 2026 Fast Facts newsletter lists several changes, most effective January 1, 2027: Cigna-insured members will require precertification for outpatient non-emergency CT, MRI and PET imaging; manual and power mobility device codes will require prior authorization for Medicare Advantage, Medicare Cost and MSHO members; Actemra is being replaced by the biosimilar Avtozma and several diabetes and insulin drugs are leaving the formulary; and Minnesota Medicaid moves to MNAAC pharmacy reimbursement. The billing team should also note the standing reminder to submit any change to a previously filed claim as a corrected claim with Bill Frequency Code 7.
Harvard Pilgrim Health Care · Effective Jan 1, 2027High impact
Point32Health Medical Necessity Guideline updates
Point32Health is updating Medical Necessity Guidelines across several plan lines. Effective 11/1/2026 (already in effect as of the 2026-11-05 analysis date), prior authorization is removed for Carelon-reviewed noninvasive prenatal testing codes 81420 and 81507 on certain commercial lines, and the 6-month trial and renewal criteria are removed for tonic motor activation. Effective 1/1/2027 (future), prior authorization is added for multiple codes on Tufts Medicare Preferred, Tufts Health Plan SCO, and Tufts Health One Care, and coverage criteria are added for SCODI, vitamin B12 and D testing, and benign skin lesion removal.
Michigan Medicaid - MDHHS · Effective Jan 1, 2027High impact
MMP 26-46: Updates to Coverage of Maternity Care Services
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.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Medical policy updates
BlueCross BlueShield of Rhode Island's November 2026 update changes prior authorization and coverage for many lab, genetic and imaging services, most of them effective January 1, 2027 for Medicare Advantage and commercial plans, including removing prior authorization for many biomarker testing codes and adding prior authorization for CPT 0154U. It also adds a physical and occupational therapy review after the 14th visit per episode for fully funded commercial plans at renewal on or after January 1, 2027, and it recorded a November 1, 2026 change that keeps the online tool criteria for shoulder replacement codes while the new draft policy is on hold.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Payment policy updates
BCBS Rhode Island issued multiple payment policy updates with staggered effective dates: pharmacy MPS lists updated (October 1, 2026—already effective), CPT 87494 (STI testing) added to preventive benefits (January 1, 2026—already effective), fee-based PCP attribution policy updated per state regulation (September 21, 2026 bulletin), and maternity/OB services billing fundamentally restructured from bundled to unbundled codes effective January 1, 2027. The OB policy change requires providers to bill individual E&M and delivery codes instead of global OB packages starting 2027.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Maternity - Obstetrical Services
BCBS RI is discontinuing bundled obstetrical billing effective January 1, 2027. Providers must transition from current bundled OB codes to individual Evaluation and Management and delivery codes per new AMA/CPT coding standards. Current bundled codes will be deleted December 31, 2026.
Aetna · Effective Jan 1, 2027High impact
OfficeLink Updates - November 2026 notices and reminders (PDF)
Aetna's November 2026 OfficeLink newsletter, issued 2026-11-01, covers several changes with different dates. The biggest is a restructuring of maternity care coding, with global maternity codes retired and replaced by service-based codes effective January 1, 2027, plus a transition period for prenatal preventive visits that began September 1, 2026. It also adds precertification for several specialty drugs on staggered dates from November 1, 2026 through February 1, 2027, and notes a Medicare MolDX molecular testing Z-code requirement that has no stated date and an observation reminder that is already in effect.
Indiana Medicaid (IHCP) · Effective Jan 1, 2027High impact
BT2026180: IHCP announces updates to maternity codes due to nationally recognized changes
Starting Jan. 1, 2027, Indiana Medicaid (IHCP) will follow the AMA's revised CPT maternity codes, and the current maternity codes will no longer be valid for dates of service on or after that date. The IHCP will no longer accept global or bundled maternity billing on any claim, including when billed as secondary, so prenatal care, labor management, delivery and postpartum care must each be billed with the appropriate codes. Prenatal and postpartum visits will be billed as E/M codes with modifier TH and the trimester or postpartum modifier, and the new labor management and delivery codes replace the discontinued ones.
Oregon Health Plan · Effective Jan 1, 2027High impact
Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes
Oregon Health Plan (OHP) is implementing three changes to the Breast and Cervical Cancer Treatment Program (BCCTP) due to federal requirements: (1) noncitizen immigration status eligibility changes effective October 1, 2026 (already in effect); (2) transition of Healthier Oregon members to OHP Open Card starting January 1, 2027, requiring providers to bill OHA directly instead of CCOs; and (3) retroactive coverage reduction from three months to two months for newly eligible BCCTP members effective January 1, 2027.
Healthfirst · Effective Jan 1, 2027High impact
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027
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.
Blue Cross Blue Shield of North Dakota · Effective Jan 1, 2027High impact
Medical Policy Updates for Migrated Members
Blue Cross Blue Shield of North Dakota is updating medical policies for two procedures effective January 1, 2027: Cervical Spinal Fusion (Surgery #244) with 23 newly added CPT codes, and Fetal Red Blood Cell Antigen Genotyping (Genetic Testing #74) with one added HCPCS code. Billing teams must update their coding systems and verify prior authorization requirements for migrated commercial members on the updated Prior Authorization List.
Anthem BCBS · Effective Jan 1, 2027High impact
[Ohio] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield is updating prior authorization (PA) requirements for Ohio-based commercial accounts, effective January 1, 2027. The policy establishes comprehensive PA requirements across inpatient admissions, advanced diagnostic testing, DME/prosthetics, transplants, gene therapies, CAR T-cell treatments, mental health services, and numerous surgical procedures. Billing teams must implement these PA requirements in their workflows and systems before the effective date.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield's October 2026 notice lists the services that will require prior authorization for national accounts commercial members starting January 1, 2027. The list is broad, covering inpatient admissions (including OB stays beyond the federal minimum length of stay), genetic and diagnostic tests, durable medical equipment, transplant and cell and gene therapies, behavioral health programs, cosmetic and reconstructive surgery, and implanted devices, so scheduling and billing need updates before that date.
Harvard Pilgrim Health Care · Effective Jan 1, 2027High impact
Changes to maternity care coding coming Jan. 1, 2027
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.
Cigna · Effective Jan 1, 2027High impact
Cigna Healthcare evaluates maternity coding options ahead of final CMS rule
This is historical material (published August 24, 2026; updated October 15, 2026; discovered October 16, 2026) outlining Cigna Healthcare's conditional approach to maternity coding changes pending a final CMS rule. Cigna will adopt either 15 new HCPCS G-codes (if CMS approves them) or the AMA maternity coding framework on January 1, 2027. Current 2026 billing guidance remains unchanged; providers should continue existing maternity billing practices through December 31, 2026.
EmblemHealth · Effective Jan 1, 2027High impact
New and Updated Reimbursement Policies
EmblemHealth has established a new formal reimbursement policy for obstetrical/maternity care services and updated multiple existing reimbursement policies (Coding Edits, E&M Services, Modifier Reference, Preventive Medicine and Screening, Prolonged Services, and Telehealth/Virtual Care Services) to align with AMA code changes effective January 1, 2027. The billing team must review the revision history for specific effective dates and implementation requirements for each updated policy.
MassHealth · Effective Jan 1, 2027High impact
All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected
Effective January 1, 2027, MassHealth will require all ordering, referring, prescribing, attending, supervising, and operating (ORPASO) providers on claims to be enrolled with MassHealth on the date of service (or within 90 days after first date of service for ordered/referred/prescribed services). Claims with unenrolled providers in these roles will be denied. MassHealth is currently sending informational denial messages to prepare providers for this enforcement.
Alabama Medicaid · Effective Jan 1, 2027High impact
Changes to Maternity Care CPT Codes for 2027
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.
Anthem BCBS · Effective Jan 1, 2027High impact
[New York] Reimbursement policy update: Maternity Services coding changes (October 2026 Newsletter)
Anthem Blue Cross and Blue Shield (New York) has issued a maternity services coding changes policy effective January 1, 2027. However, the provided policy content does not include the specific coding changes, affected CPT/HCPCS codes, or implementation details. The billing team must obtain the full policy document from the source URL to understand what codes are affected and how to implement the changes.
Anthem BCBS · Effective Jan 1, 2027High impact
[Ohio] Reimbursement policy update: Maternity Services coding changes (October 2026 Newsletter)
Anthem Blue Cross and Blue Shield has issued a maternity services coding changes policy update effective January 1, 2027. The policy document references material amendments to contract and/or changes to prior authorization requirements, but the specific coding changes are not detailed in the provided excerpt. Your billing team must access the full policy document to identify which maternity CPT codes are affected and whether new prior authorization requirements apply.
Anthem BCBS · Effective Jan 1, 2027High impact
[Ohio] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield Ohio is implementing updated prior authorization requirements for national accounts effective January 1, 2027. This comprehensive policy change expands PA requirements across inpatient admissions, advanced diagnostic testing, specialized DME/prosthetics, gene therapies, CAR T-cell treatments, mental health services, and numerous surgical procedures. Billing teams must identify all affected services and update authorization workflows to avoid claim denials.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield (Virginia) is expanding its prior authorization (PA) requirements effective January 1, 2027, for national accounts. The policy now mandates pre-certification for numerous advanced procedures, diagnostic tests, durable medical equipment, gene therapies, CAR T-cell treatments, transplants, mental health services, and surgical procedures. This represents a comprehensive broadening of PA scope across multiple service categories.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] Reimbursement policy update: Maternity Services coding changes
Effective January 1, 2027, Anthem Blue Cross and Blue Shield is restructuring maternity services coding for Georgia commercial plans. If CMS does not adopt proposed G-codes, maternity care will shift from global codes to granular reporting using separate antepartum, delivery, and postpartum codes with E/M codes, modifier TH, and frequency limits. The policy is contingent on CMS's decision; Anthem will provide updated guidance if CMS adopts alternative G-codes.
Anthem BCBS · Effective Jan 1, 2027High impact
[Georgia] National accounts: 2027 standard prior authorization requirements
Anthem Blue Cross and Blue Shield is expanding prior authorization (PA) requirements effective January 1, 2027, for Georgia commercial accounts. The policy adds comprehensive PA requirements across multiple service categories including advanced diagnostic testing (genetic testing, liquid biopsy, whole genome sequencing), specialized DME/prosthetics (robotic devices, AAC devices, bone growth stimulation), gene replacement therapies, CAR T-cell immunotherapy treatments, and numerous surgical procedures. Billing teams must update systems to require PA for these newly-covered services to avoid claim denials.
Blue Cross Blue Shield of Vermont · Effective Jan 1, 2027High impact
CMO Corner: Important Changes to Global Maternity Care Coding and Billing
Effective January 1, 2027, maternity care coding transitions from global bundled codes to encounter-based billing with 17 deleted codes, 12 new codes, and 6 revised codes. Maternity services will now be billed separately by phase (antepartum, labor management, delivery, postpartum) instead of as one combined claim. For services spanning 2026-2027, specific transition codes and modifiers apply based on antepartum visit count.
Aetna · Effective Jan 1, 2027High impact
OfficeLink Updates - October 2026 notices and reminders (PDF)
Already effective September 1 and October 1, 2026, Aetna requires precertification for drugs including Lytenava, Tudriqev, Genglycos, Pasatru, Zanvastro, and Elzonris, and requires Site of Care review for Zimrixby, Jobevne, and Avzivi. Precertification is no longer required for commercial members for OrthoVisc, Zarxio, several bortezomib products, and Fusilev, and it is no longer required for Medicare for several bortezomib products and Fusilev. Effective January 1, 2027, trauma response charges reported with revenue codes 0681 through 0684 will be denied unless a paid HCPCS code G0390 and a paid qualifying ambulance transport charge are billed on the same date of service.
Medical Mutual of Ohio · Effective Jan 1, 2027High impact
Mutual News October 2026 Newsletter
Medical Mutual released multiple policy updates effective at staggered dates: new medical policies for debridement and urodynamic testing (effective 2026-12-29), archived the FoundationOne Liquid CDx policy, updated vision therapy to include remote digital software on the investigational/experimental list, removed five VNS CPT/HCPCS codes from behavioral health coverage (codes now align with InterQual database but remain covered for epilepsy), and introduced a new Maternity Care Services Reimbursement Policy (RP-202701) effective 2027-01-01 to replace the current obstetrical policy in response to AMA CPT code revisions.
Molina Healthcare · Effective Jan 1, 2027High impact
09-01-2026 AMA updates global obstetric CPT code structure effective 01-01-27
Effective January 1, 2027, the AMA is replacing the current global obstetric CPT code structure with a disaggregated model that separately identifies antepartum care, labor management, delivery care, and postpartum services. California's Medi-Cal program intends to align with these changes pending CMS approval. Billing teams must prepare documentation and workflow changes to accommodate the new maternity care coding structure.
Utah Medicaid · Effective Jan 1, 2027High impact
September 2026 Medicaid Information Bulletin
Utah Medicaid's September 2026 bulletin includes several billing changes that begin January 1, 2027, including telehealth modifiers 93 or 95, service-level reporting for maternity care, per diem billing for residential, partial hospitalization and intensive outpatient behavioral health programs, and single-unit billing for several psychotherapy and evaluation codes. Other items already took effect, including the Spravato observation codes and the home health TE modifier change on July 1, 2026, and the nursing facility ancillary changes, which apply retroactively to services on or after July 1, 2026. Unless otherwise noted in the bulletin, changes take effect on September 1, 2026.
Blue Cross Blue Shield of Vermont · Effective Jan 1, 2027High impact
Prenatal Care and New Obstetric Billing Codes Seminar
Blue Cross Vermont is announcing upcoming changes to obstetric billing codes effective in 2027, transitioning from bundled to unbundled payment models. A webinar on September 16, 2026 will provide clinical guidance and real-world implementation strategies. The billing team must prepare for significant changes to clinical documentation and claims workflows.
Nebraska Medicaid · Effective Jan 1, 2027High impact
Maternity Service Unbundling
Nebraska Medicaid will retire 16 global maternity codes for dates of service on or after January 1, 2027, and move maternity care to E/M codes from 99202 to 99499 with the TH modifier. For antepartum visits where delivery is expected on or after that date, billing waits until after delivery, and Medicaid will allow a limited timely filing exception for certain earlier visits. New labor and delivery codes are also due January 1, 2027, with details expected in December 2026.
Ambetter · Effective Jan 1, 2027High impact
August Provider Newsletter
Ambetter of North Carolina will stop covering a list of HCPCS H codes starting January 1, 2027, and will cover H0006 from that date. Earlier changes are already effective: CPT 80320-80377 drug testing codes were no longer reimbursable from October 1, 2026, and the prior authorization changes effective October 1, 2026 took effect. The newsletter also covers surrogacy diagnosis codes Z33.3 and Z31.7, behavioral health type of bill guidance, and clinical policy updates effective 11/1/2026.
Blue Cross Blue Shield of North Dakota · Effective Jan 1, 2027High impact
Preparing for Maternity Global Coding Changes Effective Jan. 1, 2027
Blue Cross Blue Shield North Dakota is updating maternity global coding procedures effective January 1, 2027. Changes include revised reporting methods for antepartum, delivery, and postpartum services, and clarified billing expectations for split or transferred maternity care scenarios. Billing teams must review and update internal workflows and practice management systems before the effective date.
Florida Blue · Effective Jan 1, 2027High impact
Maternity Care Services Global CPT Code Changes
Effective January 1, 2027, Florida Blue and Truli for Health are eliminating global obstetric bundles and transitioning to itemized billing for maternity care. Prenatal visits, labor management, delivery, and postpartum care will be billed separately using new CPT codes (12 new codes added, 6 revised, 17 removed). Billing teams must update coding workflows, EHR configurations, and documentation practices to reflect E&M codes for prenatal/postpartum care and new labor management codes by the effective date.
Harvard Pilgrim Health Care · Effective Jan 1, 2027High impact
Changes to maternity care coding coming Jan. 1, 2027
Point32Health is restructuring maternity care CPT coding effective January 1, 2027, replacing bundled global codes with granular service-level codes organized into four phases (antepartum, labor management, delivery, postpartum). Immediately effective August 1, 2026, antepartum visits must be coded differently based on visit count: CPT 59425 (4-6 visits), CPT 59426 (7+ visits), or E/M codes (fewer than 4 visits). All antepartum codes will be deleted in 2027 and replaced with per-encounter E/M codes.
Medi-Cal · Effective Jan 1, 2027High impact
AMA to Update Global Obstetric CPT Code Structure
Effective January 1, 2027, the AMA is replacing the current global obstetric CPT code structure with a disaggregated framework that separately bills antepartum care, labor management, delivery care, and postpartum services. Medi-Cal will align with these changes subject to CMS approval, requiring billing teams to transition from bundled maternity codes to individual service-specific codes.
Indiana Medicaid (IHCP) · Effective Jan 1, 2027High impact
BT2026125: IHCP recognizes maternity procedure code changes, effective Jan. 1, 2027
Effective January 1, 2027, the American Medical Association is replacing traditional global obstetrical bundles with separate CPT codes for distinct maternity services (prenatal care, labor management, labor/delivery, and postpartum care). IHCP will recognize these new codes, representing a shift from bundled to unbundled billing. Additional policy guidance from IHCP is forthcoming.
Blue Cross and Blue Shield of Kansas City · Effective Jan 1, 2027High impact
BlueSpeak Provider Newsletter — July 2026
Blue KC is changing its maternity billing for all lines of business to align with AMA coding changes that eliminate traditional global maternity billing codes effective January 1, 2027, so providers will submit claims throughout the pregnancy instead of one global claim at delivery. Other updates include prior authorization additions for Commercial and ACA plans effective September 1, 2026, a hemodialysis URR modifier requirement effective July 1, 2026, and a post-payment review partnership with Cotiviti beginning October 1, 2026.
Security Health Plan · Effective Jan 1, 2027High impact
Provider News - July 2026
Security Health Plan discontinues its SSI Medicaid product effective Jan. 1, 2027, and members will need to transition to a new health plan for 2027; BadgerCare Plus is not affected. Maternity care billing moves from global maternity care codes to an itemized billing structure effective Jan. 1, 2027. Pharmacy benefit prior authorization requests can be submitted online through CoverMyMeds.com effective July 1, 2026, and provider questions about coordination of benefits go to (800) 548-1224 effective March 1, 2026.

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OfficeLink Updates - August 2026 notices and reminders (PDF)

MMP 26-47: Maternal Infant Health Program Rate Increase and Update to Care Coordination Requirements

Breast Imaging for Screening and Diagnosing Cancer (for Kentucky Only)

Breast Imaging for Screening and Diagnosing Cancer

Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)

OfficeLink Updates - September 2026 newsletter

Preventive Care Reminder Sent to Members

October 2026 Provider Newsletter

New and Updated Clinical Payment Policies: December 20th, 2026 (PDF)

FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027

Omnibus Codes

Fast Facts Newsletter - November 2026

Point32Health Medical Necessity Guideline updates

MMP 26-46: Updates to Coverage of Maternity Care Services

Medical policy updates

Payment policy updates

Maternity - Obstetrical Services

OfficeLink Updates - November 2026 notices and reminders (PDF)

BT2026180: IHCP announces updates to maternity codes due to nationally recognized changes

Breast and Cervical Cancer Treatment Program Updates Related to Federal Changes

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027

Medical Policy Updates for Migrated Members

[Ohio] National accounts: 2027 standard prior authorization requirements

[Virginia] National accounts: 2027 standard prior authorization requirements

Changes to maternity care coding coming Jan. 1, 2027

Cigna Healthcare evaluates maternity coding options ahead of final CMS rule

New and Updated Reimbursement Policies

All Provider Bulletin 421: Enrollment Requirement for All Providers on Claims Submitted to MassHealth - Corrected

Changes to Maternity Care CPT Codes for 2027

[New York] Reimbursement policy update: Maternity Services coding changes (October 2026 Newsletter)

[Ohio] Reimbursement policy update: Maternity Services coding changes (October 2026 Newsletter)

[Ohio] National accounts: 2027 standard prior authorization requirements

[Virginia] National accounts: 2027 standard prior authorization requirements

[Georgia] Reimbursement policy update: Maternity Services coding changes

[Georgia] National accounts: 2027 standard prior authorization requirements

CMO Corner: Important Changes to Global Maternity Care Coding and Billing

OfficeLink Updates - October 2026 notices and reminders (PDF)

Mutual News October 2026 Newsletter

09-01-2026 AMA updates global obstetric CPT code structure effective 01-01-27

September 2026 Medicaid Information Bulletin

Prenatal Care and New Obstetric Billing Codes Seminar

Maternity Service Unbundling

August Provider Newsletter

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