2027 maternity billing · encounter calculator
Rules extracted 2026-09-07 · Directory current as of 2026-09-04 · Fields read “not provided” when the payer document is silent.
How it works
Describe the encounter; get the payer's instruction and the sentence it comes from.
Pick the plan, then enter the date of service, delivery date or EDD, visit number and service phase. Each instruction the payer published is tested against those facts condition by condition — met, not met, or cannot evaluate when the payer wrote the condition narratively — and matching instructions are shown with codes, modifiers, diagnosis and Category II requirements, cost share, payer contact, the source URL and the verbatim passage. Nothing is inferred from general CPT guidance.
Select a plan to see its billing guidance.
Evidence standard
Where the answers come from
Instructions are extracted document by document from the payer sources listed in the policy directory; a rule is linked to a plan only when the document names that payer, program or product. Plans whose source contains no operational billing instruction return “no guidance found in the reviewed sources”, which is not proof that none exists.
Conditions the payer did not state are treated as unrestricted and shown as “not provided”. Category II CPT codes appear only where the document lists them. Rows marked “Possible” have at least one condition the calculator could not evaluate from the entered facts — read the quoted wording before billing.
Research note: This resource is operational policy intelligence, not legal, medical, or coding advice. Verify the member's exact payer, plan, state, line of business and date of service against the linked source before submitting claims.