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2027 Substrate Maternity Resource Center

Global billing for maternity is ending.

Today, maternity care is largely billed using a "global" code. Beginning January 1, 2027, CPT revisions will allow care to be reported more granularly at the service level. January 1 is the CPT effective date, but each payer might choose to transition billing on their own timeline.

The 2027 Substrate Maternity Resource Center tracks which of your payers are moving off global maternity billing, so you can adapt proactively. For more background, see the AMA CPT 2027 maternity care services update.

197Tracked Payers
54confirmed 2027 guidance
43proposed but not final
25pending payer guidance
16awareness notice only
59policies unchanged

Current As Of October 2026

Billing tools

Turn payer policy into billing instructions

Standardized biller rubric

What to bill, by payer

Visit-date and EDD triggers, visit-count rules, codes to bill, modifiers, diagnosis and Category II requirements, cost share, and payer contacts, each tied to the verbatim source passage.

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Encounter billing calculator

Check a single encounter

Enter the state, payer or plan, date of service, delivery date or EDD, visit number, and service phase to get that payer's own maternity billing instruction with its source.

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Interactive policy explorer

Find a payer or transition date

State results include exact state records and clearly labeled national commercial guidance. National guidance does not confirm a state-plan, Medicaid, or Medicare Advantage policy.

Showing 1 of 197 • All states • All statuses

Confirmed 2027 guidance

Blue Cross and Blue Shield of Vermont

VTTransition starts September 1, 2026

For a first visit after confirmation of pregnancy on or after September 1, 2026, bill the appropriate E/M code appended with modifier -TH and an appropriate Z34.XX or O00-O9A diagnosis code. Global maternity care and delivery codes are deleted effective January 1, 2027. A vaginal or cesarean delivery in 2026 uses the appropriate current global obstetrics codes. Seven or more antepartum visits in 2026 with delivery in 2027 use CPT 59426. Four to six use CPT 59425.

Published
2026-06
Transition starts
September 1, 2026
Billing starts
January 1, 2027
Evidence checked
2026-10-06
Billing notes and scope

Scope: Blue Cross and Blue Shield of Vermont obstetric claims. The August notice remains the upstream edition.

Transition: Apply the transition by date of service, not by the date of the initial prenatal visit. Prenatal services on or before August 31, 2026 should use an appropriate E/M code or antepartum code 59425 (4-6 visits) or 59426 (7 or more visits). Services on or after September 1, 2026 follow the E/M, -TH, and diagnosis instructions.

Global billing: The notice permits 59425/59426 as alternatives to appropriate E/M for qualifying prenatal dates of service through August 31, 2026. It does not authorize continued global billing for other services; antepartum dates of service on or after September 1 follow the specified E/M requirements.

The August 2026 notification, updated July 30, 2026, announces January 1, 2027 maternity code replacement and supplies September 1, 2026 antepartum transition instructions. It does not provide detailed billing instructions for the full 2027 code set. Confirm applicability to the member's specific product.

Client-ready download

Download your payer-mix guide and policies

One download, two files: a tailored PDF guide (cover summary, selected payers and states, the evaluation rubric, and one page per policy document with verbatim payer guidance and source links) plus a policy packet with source links and summaries for every selected payer.

Select at least one payer card above to build a guide.

Frequently asked questions

What you need to know

Is global billing for maternity ending everywhere at once?

No. CPT revisions take effect January 1, 2027, but that is not each payer's billing date. Search tracked payers to see who published a transition date, whose guidance is still proposed, and whose policies are unchanged.

What is changing about maternity billing in 2027?

Today, maternity care is largely reported using a global code. Beginning January 1, 2027, CPT revisions will allow care to be reported more granularly at the service level. Whether and when a payer moves off global billing depends on that payer's own policy.

How do I see what’s changing by payer in my market?

Search the 2027 Substrate Maternity Resource Center by payer, then open the primary policy. Confirm the transition and billing dates, and recheck the source before submitting claims. This is policy intelligence, not coding or legal advice.

Can I download policies for multiple payers?

Yes. Select payer cards and download an offline source packet containing the policy summary plus links to the maternity policy and the payer policy homepage. The source documents remain on each payer's website.

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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