What Is the Global OB Billing Transition?
The global OB billing transition is the mandatory shift from bundled maternity codes like CPT 59400 and 59510 to per-visit E/M reporting for prenatal and postpartum care, effective January 1, 2027. The AMA CPT Editorial Panel approved the deletion of 17 maternity care codes, including the four global obstetric package codes, and the addition of 12 new codes that split maternity care into four separately billable phases: antepartum, labor management, delivery, and postpartum. ACOG recommended billing E/M codes for every patient whose first prenatal visit falls on or after September 1, 2026, to avoid billing disruptions on the January 1 cutover date.
What is being deleted: 17 maternity care CPT codes are removed from the code set on January 1, 2027, including the four global packages, 59400 (vaginal delivery global), 59510 (cesarean delivery global), 59610 (VBAC global), and 59618 (cesarean after VBAC global), and the delivery-only codes such as 59409 and 59514.
What replaces them: Prenatal and postpartum visits bill as individual E/M encounters (99202 through 99499), with modifier TH recommended to flag pregnancy-related care, plus new labor management and delivery codes.
ACOG’s transition date: ACOG recommended E/M billing for every patient whose first prenatal visit falls on or after September 1, 2026. That date has passed. Patients who were already in care and deliver in 2027 are billed by counting their 2026 antepartum visits, and their 2027 visits go on E/M codes.
Why the Global OB Package Is Being Eliminated
The global obstetric package has been the standard maternity billing model since the mid-1990s. A single CPT code, such as 59400 for vaginal delivery, bundled all antepartum visits, the delivery, and postpartum care into one payment. The model worked when prenatal care followed a fixed visit schedule and most pregnancies stayed with a single provider from confirmation through delivery.
That is no longer how obstetric care is delivered. High-risk patients transfer between providers and facilities. Shared care arrangements split antepartum and delivery between different physicians. Patients present late, deliver early, or require visit frequencies that do not match the bundled assumption. The global code could not account for any of this without manual adjustments that created billing errors and underpayments.
The AMA CPT Editorial Panel voted in September 2025 to restructure maternity billing, the AMA published the new codes ahead of schedule in April 2026, and CMS released the CY 2027 Physician Fee Schedule proposed rule on July 14, 2026, which includes proposed relative values for the new codes. For the full breakdown of what CMS proposed, including the 15 G-codes CMS is considering that would keep the bundled structure for Medicare in place of the new CPT codes, see our 2027 OB/GYN billing code changes overview.
Which OB Codes Are Being Deleted on January 1, 2027?
Seventeen maternity care CPT codes are deleted from the code set on January 1, 2027. These are not being retired or made optional. They are being removed entirely, and claims using these codes for dates of service on or after January 1, 2027, will deny. The table below shows the global and antepartum codes practices bill most often.
| Deleted Code | Description | Replacement Pathway |
|---|---|---|
| 59400 | Vaginal delivery, global OB package | E/M visits + new labor and delivery codes |
| 59510 | Cesarean delivery, global OB package | E/M visits + new labor and delivery codes |
| 59610 | VBAC, global OB package | E/M visits + new labor and delivery codes |
| 59618 | Cesarean after VBAC, global OB package | E/M visits + new labor and delivery codes |
| 59425 | Antepartum care, 4 to 6 visits | Individual E/M visits with modifier TH |
| 59426 | Antepartum care, 7+ visits | Individual E/M visits with modifier TH |
| 59430 | Postpartum care only | Individual E/M visits with modifier TH |
The delivery-only codes (59409, 59514, 59612, 59620) are deleted as well. From January 1, 2027, vaginal delivery is reported with 59431 (59432 after a previous cesarean) and cesarean delivery with 59502 (primary) or 59503 (repeat). These new codes do not include labor management, which is reported separately. Everything before and after delivery, all prenatal and postpartum encounters, must now be billed as individual visits.
The Four Phases of Unbundled OB Billing
The new structure splits maternity care into four separately reportable phases. Each phase has its own billing logic, and the practice must track which phase the patient is in at every encounter.
Phase 1: Antepartum care. Each prenatal visit is billed as an individual E/M encounter using the E/M code that fits the setting (office visits are 99202 through 99215, and ACOG recommends allowing the full 99202 through 99499 range), with modifier TH appended, as ACOG recommends, to identify the visit as pregnancy-related. The E/M level is determined by the medical decision-making documented at that specific visit, not by the pregnancy as a whole.
Phase 2: Labor management. New CPT codes 59080 through 59083 cover labor management services, reported once per calendar date. These are separate from the delivery code and compensate the physician for the time and decision-making involved in managing active labor.
Phase 3: Delivery. New delivery codes replace the delivery-only codes: 59431 for vaginal delivery (59432 after a previous cesarean), and 59502 or 59503 for a primary or repeat cesarean. They do not include labor management and are billed alongside the labor management codes when labor management was performed.
Phase 4: Postpartum care. Postpartum visits after the delivery date are billed as individual E/M encounters, with modifier TH where the payer uses it, separate from the delivery payment. Same-day postpartum care is included in the delivery code. Each visit is coded to the complexity of the encounter, just like any other office visit.
In our experience matching OB/GYN providers with billing partners, the practices that will struggle most with this transition are the ones that have never billed individual E/M codes for prenatal visits. Their EHR templates, their documentation habits, and their claim workflows are all built around the global code. Every one of those has to change.
The global OB billing transition is the largest operational change in obstetric revenue cycle management in three decades. If your practice is still billing prenatal visits under the global package, the January 1, 2027 deadline is approaching. OB/GYN Bill Co matches your practice with billing companies that have already built unbundled OB workflows, free.
How to Transition Your Practice Before January 2027
ACOG recommended starting E/M billing with patients whose first prenatal visit falls on or after September 1, 2026. If your practice has not started, begin now. Here is the operational sequence.
1. Identify every active maternity patient. Pull a list of every patient who will deliver on or after January 1, 2027. These patients straddle the cutover and cannot be billed with a global code. Count each one’s 2026 antepartum visits: bill 1 to 3 visits as E/M, 4 to 6 as 59425, and 7 or more as 59426. All of their antepartum visits in 2027 are billed as E/M.
2. Update EHR templates for per-visit documentation. Each prenatal visit must now support E/M level selection based on medical decision-making. Replace the global OB template with an encounter-level template that documents the history, exam, and MDM for that specific visit.
3. Add modifier TH to prenatal and postpartum E/M claims. Modifier TH identifies the E/M visit as pregnancy-related. ACOG recommends it and some payers require it, so confirm each payer’s rule. It is the signal that separates a prenatal visit from a routine office visit for billing and reporting purposes.
4. Retrain front desk and billing staff. The global code required one claim per pregnancy. Per-visit billing requires a claim for every prenatal encounter, every postpartum visit, and the delivery separately. Staff who are used to one billing event per patient must shift to approximately 15 to 20 per pregnancy.
5. Verify payer-specific transition rules. Not every payer will handle the transition identically. Some Medicaid programs have already unbundled. Some commercial payers may follow the CMS G-code path if CMS finalizes it for Medicare. Contact your top five payers and confirm their January 2027 billing requirements.
6. Run a parallel billing test. For patients whose first prenatal visit fell on or after September 1, 2026, bill each prenatal visit as an E/M encounter, as ACOG recommends, while patients already in care finish 2026 under the current codes. This gives your team real experience with the unbundled workflow before the mandatory cutover.
Common Mistakes in the OB Billing Transition
Providers often come to us after a coding change has already created a denial wave. The practices that avoid that on the 2027 transition are the ones that catch these errors before January 1.
Holding a global claim for a January delivery. A patient who delivers on or after January 1, 2027, cannot be billed with a global code. A patient with 8 prenatal visits in 2026 who delivers in January 2027 needs those visits billed as 59426 in 2026 and the delivery billed with the new 2027 codes. Practices that plan on a global claim for that patient create a billing gap that cannot be resolved with the deleted codes.
Undercoding prenatal E/M visits. Under the global package, the E/M complexity of individual prenatal visits did not matter because the payment was bundled. Under per-visit billing, every visit is coded individually. Practices that default every prenatal visit to 99213 when the documentation supports 99214 will leave revenue on the table at every encounter.
Forgetting modifier TH. With payers that use modifier TH, a claim without it cannot be distinguished from a routine office visit. Missing the modifier can cause claim edits, incorrect patient cost-sharing, or denial for duplicate services. For the full list of modifiers and coding conventions relevant to this transition, see our OB/GYN Red Book guide.
Not tracking visit counts. The global code tracked the total visit count automatically. Per-visit billing does not. Practices must now track prenatal visit frequency independently to ensure they are billing every eligible encounter and not missing visits that go undocumented.
Assuming all payers follow the same rules. CMS may finalize G-codes that keep the bundled structure for Medicare in place of the new CPT codes. Commercial payers may adopt the new CPT codes outright. Medicaid plans vary by state. One workflow does not fit all payers.
What Does the Transition Mean for OB Practice Revenue?
The revenue impact of the transition depends entirely on how well the practice executes the switch. Done correctly, per-visit billing can increase revenue for practices that currently undercount prenatal visits or absorb additional work into the global fee without additional payment.
Under the global package, a practice that delivered 200 babies per year and billed 59400 at an average allowed amount of $2,800 collected a fixed amount regardless of how many prenatal visits each patient required. A high-risk patient who needed 20 prenatal visits generated the same payment as a low-risk patient who needed 10.
Under per-visit billing, each of those 20 visits is a separately billable E/M encounter. At an average of $110 per prenatal visit (a blended 99213/99214 rate), 20 visits generate $2,200 in antepartum revenue alone, before the delivery and postpartum codes are added. For high-risk practices, the math improves. For practices with a high volume of straightforward pregnancies and a low visit count, the math may be neutral or require careful attention to visit-level documentation to maintain revenue.
One question we hear constantly from OB/GYN practice managers is whether the transition will pay more or less overall. The honest answer is that it depends on documentation. The global code paid the same regardless of what was documented at each visit. Per-visit billing pays based on what is documented at every encounter. Practices with strong per-visit documentation will capture more. Practices with thin notes will capture less.
Frequently Asked Questions
When are the global OB codes deleted?
Seventeen maternity care CPT codes, including the global package codes 59400, 59510, 59610, and 59618, are deleted from the CPT code set on January 1, 2027. Claims using these codes for dates of service on or after that date will deny. A 2026 date of service still uses the 2026 codes, even if the claim is filed in 2027.
What is modifier TH in obstetric billing?
Modifier TH identifies an E/M visit as pregnancy-related during the transition to per-visit obstetric billing. It is appended to prenatal and postpartum E/M codes to distinguish them from routine office visits. ACOG recommends it; some payers require it, while others rely on pregnancy diagnosis codes instead, so check each payer’s policy.
Do delivery-only codes change in 2027?
Yes. The delivery-only codes (59409 for vaginal, 59514 for cesarean, 59612 for VBAC, 59620 for cesarean after VBAC) are deleted on January 1, 2027. Vaginal delivery is then reported with 59431 (59432 after a previous cesarean) and cesarean delivery with 59502 (primary) or 59503 (repeat). The new codes do not include labor management, which is reported separately with 59080 through 59083.
When should practices start the transition?
Now. ACOG recommended E/M billing for every patient whose first prenatal visit fell on or after September 1, 2026. For patients already in care whose pregnancy spans January 1, 2027, bill 2026 antepartum visits by count (1 to 3 as E/M, 4 to 6 as 59425, 7 or more as 59426) and all 2027 antepartum visits as E/M.
Will all payers follow the same unbundled billing rules?
No. CMS is considering 15 G-codes that would keep the bundled structure for Medicare in place of the new CPT codes, with a final decision expected in early November 2026. Commercial payers and state Medicaid programs may adopt different approaches. Practices should verify the billing requirements with each payer individually before January 1.
How does per-visit OB billing affect split care?
Per-visit billing simplifies split care. Under the global package, transferring a patient between providers required complex antepartum-only codes and manual calculations. Under per-visit billing, each provider bills the E/M visits they performed, and the delivering provider bills the delivery codes. Each physician is paid for the work they documented.
Does this affect gynecology codes?
No. The 2027 restructure applies only to obstetric maternity care codes. Gynecology codes for hysterectomy, colposcopy, IUD management, and all other GYN procedures remain unchanged.
Next Steps
Read the full 2027 OB/GYN billing code changes overview for the CMS proposed rule details, and our CMS G-codes update for where the G-code dual-path question stands.
Review the OB/GYN Red Book guide for the coding conventions and modifiers relevant to the transition.
Start your EHR template updates and staff training now, before the January 1 deadline.
Ready to transition your OB billing workflow? Get matched with a billing partner that has already built the unbundled process.
The global OB package is ending. Per-visit billing rewards practices that document every prenatal encounter at the correct E/M level, and it penalizes the ones that do not. OB/GYN Bill Co matches your practice with vetted billing companies that specialize in obstetric revenue cycle management, including the 2027 unbundled transition. Free quotes, all 50 states, rates starting at 2.95%.
