Maternity care and obstetrical CPT codes: What’s changing in 2027
The new coding structure addresses challenges faced by family physicians in getting appropriate payment for maternity care.
The maternity care landscape has changed drastically in the 30 years since the maternity code set was developed. It can be difficult under the current system to get payment for additional visits and extra care. New codes going into effect January 1, 2027, will better reflect the increased focus on morbidity and mortality and that there are:
More antepartum visits per patient needed than current codes support
More patients experiencing longer and increasingly complex labor and delivery
More care transfers to tertiary care centers
New maternity services codes overview
Beginning January 1, 2027, coding for maternity care and delivery services will be restructured. Maternity care services that were previously reported using a single global code will be unbundled and reported using separate codes. Maternity care services will be divided into four distinct sections:
Antepartum care: Reported as separate encounters using E/M codes, most typically, office and outpatient visits
Labor management care: New subsection containing four CPT codes (59080, 59081, 59082, 59083) to report care provided from the start of labor until delivery, reported in addition to delivery care
Delivery care: Revised subsection that includes two new vaginal and two new cesarean delivery codes
Postpartum care: Reported as separate encounters using E/M codes, most typically, office and outpatient visits
Code deletions and replacements in the 2027 CPT obstetrical update
| Deleted vaginal delivery codes | Replaced with |
| 59400 routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care |
|
| 59409 vaginal delivery only (with or without episiotomy and/or forceps) | 59431, 59432 vaginal delivery codes |
| 59410 vaginal delivery only (with or without episiotomy and/or forceps) including postpartum care |
|
| Deleted antepartum care codes | Replaced with |
| 59424 antepartum care only 4 to 6 visits | E/M codes |
| 59426 antepartum care only 7 or more visits | E/M codes |
| Deleted postpartum care code | Replaced with |
| 59430 postpartum care only | E/M codes |
| Deleted cesarean delivery codes | Replaced with |
| 59510 routine obstetric care including antepartum care, cesarean delivery and postpartum care |
|
| 59514 cesarean delivery only |
59502 cesarean delivery; primary or 59503 Cesarean delivery repeat |
| 59515 cesarean delivery inlcuding postpartum care |
|
| Deleted vaginal delivery codes after prior c-section | Replaced with |
| 59610 routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery |
|
| 59612 vaginal delivery only, after previous cesarean delivery (with or without episiotomy, and/or forceps) |
|
| 59614 vaginal delivery only, after previous cesarean delivery (with or without episiotomy, and/or forceps) including postpartum care |
|
| Deleted c-section codes after attempted vaginal delivery | Replaced with |
| 59618 routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery |
|
| 59620 cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery | 59503 cesarean delivery repeat |
| 59622 cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care |
|
| 59050 fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report; supervision and interpretation | 59051 fetal monitoring during labor by consulting physician (i.e., non-attending physician) or other qualified health care professional, with interpretation and report |
Codes and FAQs by service
Review how codes are changing for each area of maternity care and find answers to common questions.
CPT defines antepartum as the care during pregnancy prior to the onset of labor. Confirmation of pregnancy is reported at an encounter with an E/M code (typically an office visit).
Beginning in 2027, all antepartum care is encounter-based instead of reported through the maternity global codes or antepartum bundle codes (CPT codes 59425 and 59426). All routine prenatal visits will be reported at the time of service using E/M codes (e.g., office/outpatient, inpatient, home or residence, etc.).
You will use the same E/M guidelines for antepartum care as you would for all other care reported through E/M codes. The level of service will vary based on the work at each individual encounter and may be selected using either medical decision making or total time.
Pregnancy is considered a condition under the MDM element “Number and Complexity of Problem(s) Addressed.” Normal pregnancy can be categorized as “moderate” for the element.
If a patient goes to the hospital while pregnant, but isn’t in labor, use Emergency Department codes for ED visits, and initial and subsequent hospital visits for observation or inpatient stay. If the patient is in labor, report labor management codes.
How will we bill for services when we provide care to a pregnant patient in 2026 but they deliver in 2027?
Because the maternity care codes are changing January 1, 2027, coding for patients who are pregnant in 2026 but will deliver their babies in 2027 will require using codes from both code sets. Learn how to use restructured code sets by service area.
In general, you can use the patient’s due date to determine how to report antepartum care.
Count the number of prenatal visits provided in 2026 and report using the existing antepartum codes and guidelines. Use the new labor management and delivery care codes when the patient delivers in 2027.
- 1 to 3 visits: E/M code (e.g., 99213)
- 4 to 6 visits: 59425
- 7 or more visits: 59426
Starting September 1, 2026, report pregnancies with a first 10-week visit with existing E/M codes and the appropriate ICD-10 code.
Beginning in 2027, all antepartum visits should be reported as they happen with patient E/M codes (e.g., 99213). Append the TH modifier, as appropriate and in accordance with your payers’ policies. Do not use the global care maternity codes (CPT 59400, 59510, 59610) or antepartum care bundles (CPT 59425, 59426) to report antepartum care.
Starting in 2027, labor management will be a distinct service that is reported separately from delivery. Per CPT, labor management “involves integrated decision making to assess, support, and balance the well-being of the parturient (ie, pregnant person who is in labor or preparing for birth) and fetus(es), including managing medical conditions or complications…”
- Labor day management services are calendar day codes and reported once per day. They require a face-to-face encounter.
- Labor day management is broken down into initial and subsequent management. The level of service is based on labor complexity.
Labor management CPT codes
| CPT code | Description |
| 59080 | Initial labor day management; straightforward, per day |
| 59081 |
Initial labor day management; complex, per day |
| 59082 | Subsequent labor day management; straightforward, per day |
| 59083 | Subsequent labor day management; complex, per day |
Initial vs. subsequent
The initial day of labor management begins when the patient requires labor management or induction begins. You will use the subsequent day labor management codes for each additional calendar day the patient is in labor.
A continuous visit that crosses midnight will be considered one service. CPT defines a continuous visit as “requiring continuous personal physician or other QHP attendance at bedside or elsewhere on the floor or unit focused on a single parturient.”
Once labor management begins, do not report any other E/M services on that day.
Labor complexity
To qualify as straightforward, all criteria listed in the AMA guidelines must be met. If all are not met, the labor management encounter will be considered complex.
If a patient begins with a straightforward presentation for labor but increases in complexity, you will report complex labor management for that date. You should not report both straightforward and complex on the same day.
When does labor management end and delivery services begin?
Per CPT, “Delivery care begins when labor is complete (presenting part of the fetus is visible and firmly rimmed by the vaginal introitus) or interrupted (eg, arrest of labor is diagnosed and a subsequent decision for cesarean delivery is made). Delivery care includes management of the parturient and fetus(es).”
Labor management should not be reported for a scheduled or planned cesarean delivery (unless labor occurs).
A patient was admitted for labor management in the afternoon. My covering partner took over at 6 pm. How do we bill that?
Physicians and other QHPs in the same group, same specialty are paid as if they were one physician. The group will bill the labor management code for that day.
How often are the new labor management codes billed?
Labor management is reported once per calendar day. Do not report a separate E/M for the admission. Only one labor management code is reported per day, unless the patient requires transfer from one group to another group. For example, a patient laboring in a rural hospital is transferred to a tertiary care center. Both the physician in the rural hospital and the physician in the tertiary care center report labor management services.
Multiple visits by the same physician or, in a group, same specialty partner (physician and other qualified health care professional) are reported with a single code.
Does the duration of labor make a difference in determining straightforward or complex labor management code selection?
No, the level of management is based on the patient and fetus(es) condition and the complexity (see above). Labor management that extends beyond the first calendar day may be reported with the subsequent labor management codes.
Coding for delivery care will be revised and include four new codes – two vaginal delivery codes and two cesarean delivery codes.
Vaginal delivery
| CPT code | Description |
| 59431 | Vaginal delivery, with or without episiotomy |
| 59432 | After previous cesarean delivery |
Repair services to list with delivery codes
CPT codes 59433 and 59434 may be separately reported by any physician, including the delivering physician.
| CPT code | Description |
| 59300 | Repair of first or second-degree episiotomy or laceration by other than attending or QHP performing vaginal delivery care (separate procedure) |
| 59433 | Repair of episiotomy or laceration; third-degree laceration |
| 59434 | Repair of episiotomy or laceration; fourth-degree laceration |
Cesarean delivery
| CPT code | Description |
| 59502 | Cesarean delivery; primary |
| 59503 | Cesarean delivery; repeat |
Starting in 2027, the existing postpartum care codes will be deleted. Like antepartum care, postpartum care will be reported using E/M codes.
Inpatient visits and/or a discharge on a day after delivery will be reported using the appropriate hospital inpatient and observation E/M code (99221-99239) or critical care services E/M code (99291, 99292). Routine postpartum care on the same day as delivery is included in the delivery code.
All outpatient postpartum visits will be reported using the appropriate E/M service (e.g., 99213).
What if the patient delivers at 2 a.m. and is seen on the floor at 10 a.m. Do we bill a postpartum hospital visit?
No, routine postpartum care is included in the delivery. A separate E/M should not be reported on the day of delivery.
Diagnosis codes
Key points for diagnosis coding throughout the pregnancy and delivery are:
Each antepartum encounter will require a diagnosis code. For normal pregnancy, use “Z34.xx, Encounter for supervision of normal pregnancy.” These codes are defined by trimester and whether it is the patient’s first pregnancy or a later pregnancy. Codes from the “Z3A, Weeks of Gestation” category can be used to provide additional information.
For an encounter that is incidental to the pregnancy, use “Z33.1, Pregnant state, incidental.”
For patients with conditions that affect the management of the pregnancy, childbirth, and the puerperium, use a code from Chapter 15 of ICD-10-CM: Pregnancy, Childbirth, and the Puerperium (O09-O29). These codes take priority precedence over other codes. Many of the codes include the trimester as the final character.
Codes from the O09 category are used for supervision of high-risk pregnancy, when there isn’t a current problem at the encounter, but the pregnancy is defined as high risk due to history or risk factors.
Some groups may not have selected the most specific ICD-10 code for visits if the visit wasn’t being reported separately because it was part of global reporting. Accurate ICD-10 coding and documentation will be important to support prenatal visits, particularly for patients at high-risk that require frequent visits.
How to prepare to use updated obstetrical codes
For a smooth transition to the new system:
Familiarize yourself with the new codes and guidelines.
Verify that your EHR and billing systems will be updated. Discuss how the new changes will impact your billing and revenue workflows.
If multiple groups or physicians are involved in the care, discuss how you will handle reporting each phase of care (antepartum, labor management, delivery and postpartum).
Review the ACOG Toolkit for Talking to Payers and AMA – A Health Plan Primer: Previewing the CPT 2027 Restructure for Maternity Care Services for additional tips.
Talk with your payers.
Talking to payers about maternity care coding changes
Ask your payers if they will be ready for implementation January 1, 2027, and if they intend to publish written guidance or updated policies on reporting the new codes.
Talk with your provider relations representatives to understand how the coding changes may impact your contracts and fee schedules.
Ask payers if they are adopting the “TH” modifier. AAFP, ACOG and others have recommended that they adopt the HCPCS modifier “TH” to indicate that an E/M is for prenatal or postpartum care. If they aren’t, ask them if they will have any requirements for reporting prenatal or postpartum care.
Clarify with payers how they will ensure prenatal visits and screening for ACA-compliant plans will not be subject to cost-sharing.
Monitor your remittance advices and denials closely. Report payer-specific issues through the payer’s provider relations channels.