Status as of October 27, 2026: the new CPT codes are final for January 1, 2027. Medicare’s payment values and the G-code question are still proposals until CMS publishes the final CY 2027 Physician Fee Schedule rule.
What are the 2027 maternity billing changes?
For decades, most pregnancy care has been billed under one global code that bundles roughly nine months of prenatal visits, delivery and postpartum care into a single payment. Starting January 1, 2027, that bundle breaks apart.
The American Medical Association’s CPT 2027 update deletes 17 maternity codes, adds 12 and revises six. Care is now reported across four phases: antepartum (prenatal) care, labor management, delivery and postpartum care. The reason is practical. Pregnancy care is often delivered by several care teams, sometimes unaffiliated, and a single global code cannot show who did what.
For employers, one line on a claim becomes several. More line items mean more visibility into where maternity dollars go. They also mean more places where cost sharing, coding intensity and pricing can drift.
Where does CMS propose to move the money?
CMS released its CY 2027 Physician Fee Schedule proposed rule, published in the Federal Register on July 16, 2026. In it, CMS explains that the old global codes assumed 12 prenatal visits. ACOG’s May 2025 guidance describes a sample schedule of 8 visits for an average-risk pregnancy and 13 for higher-risk pregnancies.
CMS proposed removing four visits from its utilization estimate and moving that value to the new labor and delivery codes. By CMS’s own math, that reallocates 11,810 work RVUs and raises the work RVUs for each labor and delivery code by 15% above the AMA committee’s recommendation. CMS also wrote that it is not endorsing fewer prenatal visits for pregnant women.
In plain terms, labor and delivery codes could gain value while prenatal and postpartum visits lose it. Medicare sets the reference point, and many commercial fee schedules follow its relative values, so these shifts tend to reach the plans you sponsor.
What is final, and what is still proposed?
Separating what is settled from what is still moving is the first step toward a real plan.
| Final | Still proposed or unknown |
|---|---|
| New CPT maternity codes take effect January 1, 2027 | Medicare’s final payment values for each new code |
| The global code structure is replaced by four phases of care | Whether CMS creates 15 G-codes that keep the old global structure for Medicare |
| CMS’s proposal is on the record, and comments closed September 14, 2026 | How carriers and TPAs will price and adjudicate the new codes |
As of October 27, 2026, the Federal Register showed no final CY 2027 Physician Fee Schedule rule. The IFEBP’s October 20 status update said the final rule was expected in November. When it is published, check the final values and the G-code decision against the table above.
Could maternity billing run on two systems?
This is the detail every benefits leader should watch. In the proposed rule, CMS asked for comment on creating 15 HCPCS G-codes that reflect the old global maternity structure, to be used for Medicare payment in place of the new CPT codes. As Georgetown University’s Center for Children and Families explains, ACOG and others have raised concerns about the added burden of running parallel codes.
If CMS creates the G-codes, some payers could keep paying the old way while others move to the itemized codes. Two billing approaches could then apply to the same pregnancy, especially when a member changes providers or care teams partway through.
Why does this hit employer health spending?
Pregnancy and childbirth are already one of the larger cost categories in most employer plans. The Peterson-KFF Health System Tracker, using employer plan claims from 2021 through 2023, found:
| Measure | Average cost in employer plans |
|---|---|
| Pregnancy, childbirth and postpartum care | $20,416, including $2,743 out of pocket |
| Vaginal delivery | $15,712, including $2,563 out of pocket |
| C-section delivery | $28,998, including $3,071 out of pocket |
Now layer the 2027 changes on top of that baseline.
If your plan is fully insured, carriers price uncertainty into renewals. When a major cost category is being recoded and revalued at the same time, expect some of that uncertainty to appear as margin in your 2027 rates. KFF Health News reported that experts are watching whether visit intensity rises under the new codes, and if plans pay more, premiums follow.
If your plan is self-funded, you will see the change directly in claims. Itemized billing can mean each phase of care meets the deductible and coinsurance separately, which changes what members pay and what the plan pays. It also changes the data your TPA sends back to you, which is useful if someone reads it. For how the two funding models differ, see self-funded vs. fully insured.
How do you build predictability into a 2027 renewal?
You cannot control how CMS finalizes the rule. You can control how prepared your plan is when it lands.
Model maternity claims by phase of care. Ask your TPA or carrier to break the last two to three years of maternity claims into prenatal, delivery and postpartum buckets. That gives you a baseline to compare against once itemized codes start flowing, and it shows where the proposed value shifts would hit hardest. Ethos Benefits does this work as part of its claims analytics for self-funded and fully insured clients.
Get written answers from your carrier or TPA:
- Will you use the new CPT codes, G-codes or both in 2027?
- How will you adjudicate a pregnancy that spans both billing approaches?
- Are your provider contracts tied to Medicare relative values, and when will rates update?
- How will 2027 claims reporting separate the four phases of care?
Review plan design and member cost sharing. If each phase is billed separately, members may face cost sharing at several points instead of one. Check how the deductible, coinsurance and out-of-pocket maximum apply to maternity care, so families are not surprised partway through a pregnancy. Any change needs plan document and SPD updates and clear employee communication.
Check stop-loss and set a contingency. For self-funded groups, confirm how your stop-loss contract treats maternity and newborn claims, including NICU stays. Then build a modest contingency for the maternity category into the 2027 budget instead of assuming last year’s trend holds. The health plan renewal timeline shows where each of these steps fits.
Which levers reduce maternity cost?
The billing changes decide how maternity care is priced. Clinical outcomes decide how much of it the plan pays for. The biggest swings in maternity spending come from a small number of high-cost events, and that is where strategy should focus.
Find high-risk pregnancies early. The CDC found that more than 80% of pregnancy-related deaths were preventable, based on 2017 to 2019 data. Flagging conditions like hypertension, diabetes and behavioral health needs early protects families first, and it also reduces the costly complications that follow late intervention.
Plan for NICU exposure. Peterson-KFF found that children admitted to a NICU as newborns averaged $77,992 in health costs over their first 18 to 24 months, and $117,878 for the highest level of NICU care. Children with no NICU stay averaged $14,268. Preventing even one avoidable preterm birth can change a plan’s year.
Address avoidable C-sections. Peterson-KFF reports that about a third of U.S. births are by C-section (32.3% in 2023). In employer plans, a C-section averages $28,998 against $15,712 for a vaginal delivery. Helping members find hospitals and doctors with lower rates of medically unnecessary C-sections improves outcomes and lowers cost at the same time.
Each of these levers improves care for members and lowers plan exposure. When benefits are designed around better outcomes, cost control follows.
What should employers do now?
- Confirm whether your plan is fully insured or self-funded, and who will decide how the new codes are paid.
- Pull a maternity claims baseline by phase of care.
- Send the four questions above to your carrier or TPA and ask for written answers before renewal.
- Review maternity cost sharing and update plan documents if anything changes.
- Confirm stop-loss treatment of maternity and NICU claims.
- Watch for the final CY 2027 Physician Fee Schedule rule and recheck the G-code decision when it is published.
Plans that can see claims in detail are the ones that can manage them. Kalos Services, for example, paid 81% less than billed on $16.7 million in medical claims. The Kalos Services case study shows how claims-level visibility fits into running the plan.
This article is general information, not legal, tax or medical advice. It reflects the CY 2027 Physician Fee Schedule proposed rule as of October 27, 2026, and will be updated when CMS publishes the final rule.