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When does HIGHMARK BLUE CROSS BLUE SHIELD change OB/GYN billing?

Confirmed 2027 guidance

Transition
October 1, 2026 — start the new model for 2027 due dates
Billing
January 1, 2027 — global maternity codes retired
Published
September 28, 2026

For pregnant members with due dates on or after Jan. 1, 2027, providers should begin transitioning on Oct. 1, 2026 by using E/M codes with the TH modifier only. Current global maternity codes are retired on Jan. 1, 2027, when labor and delivery CPT codes become available. Seven or more antepartum visits bill CPT 59426, 4-6 bill CPT 59425, and fewer than 4 bill E/M codes with the TH modifier.

Not published.

Patients who initiate maternity care on or after Oct. 1 are not eligible for global maternity billing.

Highmark professional and facility notice. Other Highmark records are not included on this row.

Source: Guidance on the new coding and billing model for maternity care

Last checked

Questions about HIGHMARK BLUE CROSS BLUE SHIELD

When does HIGHMARK BLUE CROSS BLUE SHIELD change OB/GYN billing?

HIGHMARK BLUE CROSS BLUE SHIELD has published 2027 OB/GYN billing guidance. Transition: October 1, 2026 — start the new model for 2027 due dates. Billing: January 1, 2027 — global maternity codes retired. For pregnant members with due dates on or after Jan. 1, 2027, providers should begin transitioning on Oct. 1, 2026 by using E/M codes with the TH modifier only. Current global maternity codes are retired on Jan. 1, 2027, when labor and delivery CPT codes become available. Seven or more antepartum visits bill CPT 59426, 4-6 bill CPT 59425, and fewer than 4 bill E/M codes with the TH modifier.

What do I bill HIGHMARK BLUE CROSS BLUE SHIELD for prenatal visits in 2027?

For pregnant members with due dates on or after Jan. 1, 2027, providers should begin transitioning on Oct. 1, 2026 by using E/M codes with the TH modifier only. Current global maternity codes are retired on Jan. 1, 2027, when labor and delivery CPT codes become available. Seven or more antepartum visits bill CPT 59426, 4-6 bill CPT 59425, and fewer than 4 bill E/M codes with the TH modifier. Patients who initiate maternity care on or after Oct. 1 are not eligible for global maternity billing.

Has HIGHMARK BLUE CROSS BLUE SHIELD published 2027 maternity guidance?

Yes. HIGHMARK BLUE CROSS BLUE SHIELD has published 2027 maternity guidance. Last checked October 6, 2026. Source: Guidance on the new coding and billing model for maternity care.

HIGHMARK BLUE CROSS BLUE SHIELD payer page2027 Substrate Maternity Resource Center

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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