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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.

Open the rubric →

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.

Open the calculator →

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

Highmark Blue Shield of Northeastern New York

NYTransition starts June 1, 2026

Medicaid products of this Highmark brand (MMC, HARP, CHPlus, EP) follow the NYS Medicaid directive: members who initiate prenatal care on/after 2026-06-01 and/or have an EDD on/after 2027-01-01 -> prenatal visits billed E/M + modifier TH with pregnancy O/Z diagnoses; full AMA 2027 code set from 2027-01-01. For commercial and Medicare Advantage members Highmark has announced only a review (2026-07-01 notice) and no operational change.

Published
2026-07-01
Transition starts
June 1, 2026
Billing starts
January 1, 2027
Evidence checked
2026-08-28
Billing notes and scope

Scope: Split by product: NYS Medicaid cohort rules for MMC/HARP/CHPlus/EP only; commercial and Medicare Advantage remain under Highmark's awareness notice

Transition: Transition 2026-06-01 per NYS cohort; billing 2027-01-01. Article defers detail to NYS Medicaid Update April 2026.

Global billing: Per NYS Medicaid: unavailable when the service span includes dates on/after 2027-01-01; established prenatal patients before 2026-06-01 may continue current billing through 2026-12-31.

Advance notice only; monitor each market's bulletins and reimbursement policies. Match applied from payer family/program metadata; confirm the exact member product before submission.

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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