Aetna
NATIONALTransition starts September 1, 2026
National commercial guidance — verify the member's plan applicability.
For Aetna commercial and Medicare members, the announced CPT framework replaces global maternity codes with service-level coding across antepartum, labor management, delivery and postpartum care beginning 2027-01-01; operational and claims-processing details remain forthcoming. For qualifying patients expected to deliver in 2027, bill preventive prenatal visits on or after 2026-09-01 with the applicable E/M code, modifier TH and pregnancy diagnosis code(s), subject to the stated visit-count rule.
- Published
- 2026-09
- Transition starts
- September 1, 2026
- Billing starts
- January 1, 2027
- Evidence checked
- 2026-08-28
Billing notes and scope
Scope: Aetna commercial and Medicare medical maternity services. This article does not establish applicability to Medicaid, dental, vision or separately identified affiliates and products.
Transition: For patients expected to deliver in 2027, preventive prenatal visits on or after 2026-09-01 should be billed with the applicable E/M code, TH and pregnancy diagnosis code(s) when three or fewer visits are provided before 2027-01-01. Once four prenatal visits have occurred in 2026, follow current antepartum coding guidelines. The article does not specify a preventive E/M code family.
Global billing: The article directs current antepartum coding once four prenatal visits occur in 2026; it does not grant blanket permission to continue global maternity billing. Global maternity codes are announced for retirement on 2027-01-01, with implementation details forthcoming.
For fully insured plans written in Texas, the maternity changes apply only if consistent with applicable regulatory requirements; other plans follow the article. Routine prenatal and postpartum office E&M visits are described as preventive with no member cost-share and require TH plus an appropriate diagnosis; TH alone does not establish preventive status. Non-routine visits should not use TH and should be billed for the medical reason for the encounter.