January 1, 2027 — CPT framework; implementation details forthcoming
Published
September 2026
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.
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.
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.
Aetna commercial and Medicare medical maternity services. This article does not establish applicability to Medicaid, dental, vision or separately identified affiliates and products.
Aetna has published 2027 OB/GYN billing guidance. Transition: September 1, 2026. Billing: January 1, 2027 — CPT framework; implementation details forthcoming. 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. 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.
What do I bill Aetna for prenatal visits in 2027?
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. 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 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.
Has Aetna published 2027 maternity guidance?
Yes. Aetna has published 2027 maternity guidance. Last checked August 28, 2026. Source: OfficeLink Updates — September 2026: Maternity care services coding changes.
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.
This website uses cookies to ensure you get the best experience on our website. Learn more
