2027 maternity billing · standardized biller rubric

73rubric rows

39payer source documents

52rows with explicit billing guidance

13rows naming Category II codes

26sources with contact or follow-up

Rubric generated 2026-09-07 · Directory current as of 2026-09-04 · Cells read “not provided” when the payer document is silent.

How to read this rubric

One row per payer instruction, in the payer's own words.

Each row states the conditions a payer attached to an instruction (visit date, delivery date or EDD, visit number, service phase), what to bill and what not to bill, and the verbatim passage it was taken from. Nothing is inferred from general CPT guidance: if a document does not name a modifier, diagnosis rule, Category II code or contact, the cell says so. Use the policy directory for each plan's overall status and source links.

73rubric rows

39source documents

52rows with explicit billing guidance

13rows naming Category II codes

63rows tied to a directory plan

26sources with contact or follow-up

Every row is extracted from one payer document (generated 2026-09-07; each quote verified against the retrieved text). A cell reads not provided when the document is silent, Inferred when the reading is not stated verbatim, and Category II codes appear only where the document lists them. The plans column is resolved against the current policy directory, so plans removed or re-labelled by the directory review are reflected here.

SearchSource documentGuidanceDirectory plans

73 rows

Directory plans	Payer	Product / Line of business	Visit Date	Delivery Date (EDD)	Visit Number	Visit Type	Service Phase	Billing Decision	Codes to bill	Modifier	Diagnosis requirement	Category II CPT required	Codes NOT to bill	Cost Share	Obligation	Guidance	Effective / published	Instruction status	Payer contact	Further guidance promised	Source	Verbatim source text
Some plans in directory 2/46 plans published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 9/1/2026	>= 1/1/2027 ('expected to deliver in 2027')	<= 3 prenatal visits before 1/1/2027	Routine (preventive) prenatal	Antepartum	E/M code + modifier TH + pregnancy diagnosis code(s)	Applicable E/M code	TH	Pregnancy diagnosis code(s) linked to the E/M	not provided	Global / antepartum bundle for these visits	$0 (routine prenatal/postpartum E/M are preventive, no member cost-share)	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational transition guidance; 2027 claims-processing details still to come	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-09-07	“For patients expected to deliver in 2027, preventive prenatal visits on or after September 1, 2026 should be billed with the applicable E/M code, modifier TH and pregnancy diagnosis code(s) when three or fewer visits are provided before January 1, 2027.”
Some plans in directory 2/46 plans published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 9/1/2026	>= 1/1/2027	>= 4 prenatal visits in 2026	Routine prenatal	Antepartum	Current antepartum coding guidelines (global/antepartum bundle)	Current antepartum codes (59425/59426 by count) - codes not named in article	not provided	not provided	not provided	E/M+TH for these visits (not stated; inferred from 'follow current antepartum coding')	$0	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational transition guidance	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-09-07	“Once four prenatal visits have occurred in 2026, billing should follow the current antepartum coding guidelines.”
Some plans in directory 2/46 plans published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	Any	<= 12/31/2026	Any	Routine prenatal	All	Current guidelines (global billing)	not provided	not provided	not provided	not provided	not provided	$0 for routine preventive visits	not provided	Inferred (article only addresses 2027 deliveries)	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	current policy (inferred)	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-09-07	not provided
Some plans in directory 2/46 plans published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	>= 1/1/2027 (DOS)	Any	Any	Any	All	Bill maternity services individually under the new CPT framework (antepartum, labor management, delivery, postpartum); operational details forthcoming	New 2027 CPT codes (not enumerated)	not provided	not provided	not provided	Deleted global codes	$0 for routine prenatal/postpartum E/M	will (framework final)	Provided (framework only; codes/claims rules not provided)	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	announced; implementation details pending	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-09-07	“The overall coding framework is final, but implementation details, such as those related to operations and claims processing, are still to come.”
Some plans in directory 2/46 plans published	Aetna	Commercial and Medicare ('This update applies to commercial and Medicare members')	Any	Any	Any	Non-routine (medical condition / complication)	Antepartum / Postpartum	Bill by the medical reason for the encounter, WITHOUT modifier TH	E/M by medical reason	none (do not use TH)	Diagnosis for the medical condition	not provided	TH-appended E/M	Subject to member cost-share	should	Provided	Published Sept 2026 OfficeLink Updates; framework effective 1/1/2027; transition guidance from 9/1/2026	operational	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	D02https://es.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-september-2026-olu.pdfverified 2026-09-07	“Non-routine prenatal and postpartum E&M office visits shouldn't be submitted with modifier TH and are subject to member cost-share.”
In directory 1/1 plan published	Aetna Better Health of Florida	Medicaid	>= 1/1/2027 (DOS)	Any	Any	Any	All	Global OB bundling ends; itemized coding - coding and claims-edit details not finalized	not provided	not provided	not provided	not provided	Global maternity codes (from 1/1/2027)	not provided	will	Provided (date only; billing rules not provided)	Effective 1/1/2027	awareness; operational details pending	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	D03https://ch.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_End_of_OB_Bundled_Billing.pdfverified 2026-09-07	“Effective January 1, 2027, the AMA will eliminate traditional global maternity CPT codes and replace them with a more granular, itemized framework”
In directory 1/1 plan published	Aetna Better Health of Florida	Medicaid	< 1/1/2027	Any	Any	Any	All	not provided	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	D03https://ch.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/abhfl_End_of_OB_Bundled_Billing.pdfverified 2026-09-07	not provided
Some plans in directory 1/21 plans published	Cigna Healthcare	Commercial (provider newsroom)	>= 9/1/2026 (initial prenatal visit)	Any	Any	Routine prenatal	Antepartum	Continue current contractual maternity billing (global); do NOT submit the ACOG/AMA-recommended prenatal E/M codes because of the 9/1/2026 date	Existing contracted maternity codes	not provided	not provided	not provided	Prenatal E/M codes submitted solely due to first visit on/after 9/1/2026	not provided	must (do not)	Provided	Published 2026-08-24	current policy maintained; 2027 guidance promised later in 2026	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	D04https://providernewsroom.com/cigna-healthcare/update-on-maternity-coding-and-reimbursement/verified 2026-09-07	“not changing its current maternity billing guidance at this time”
Some plans in directory 1/21 plans published	Cigna Healthcare	Commercial (provider newsroom)	>= 1/1/2027 (DOS)	Any	Any	Any	All	Not yet issued - additional guidance promised	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	pending	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	D04https://providernewsroom.com/cigna-healthcare/update-on-maternity-coding-and-reimbursement/verified 2026-09-07	not provided
Some plans in directory 2/11 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	>= 9/1/2026	Any	Any	Prenatal or postpartum	Antepartum / Postpartum	E/M 99202-99215 + TH (encouraged, not required)	99202-99215	TH	not provided	not provided	not provided	not provided	encouraged (may)	Provided	Bulletin 2026-07-10; encouragement from 9/1/2026	operational (permissive)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use Evaluation and Management codes (E/M 99202-99215) with the TH modifier, to indicate prenatal or postpartum care.”
Some plans in directory 2/11 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	< 1/1/2027 (DOS)	Any	Any	Any	All	Global/bundled codes remain acceptable; health plans may not require individual E/M in lieu of bundled codes	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	may	Provided	Bulletin 2026-07-10	operational	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“health plans may not require the use of individual E/M codes in lieu of current bundled codes for dates of service prior to Jan. 1, 2027.”
Some plans in directory 2/11 plans published	NC Medicaid (NCDHHS)	NC Medicaid Direct and NC Medicaid Managed Care	>= 1/1/2027 (DOS)	Any	Any	Any	All	All current maternity codes incl. global deleted from fee schedule; use new AMA codes	New AMA maternity codes (not enumerated)	not provided	not provided	not provided	All current maternity service codes incl. global	not provided	will	Provided (codes not enumerated)	Effective 1/1/2027	operational (announced)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	D05https://medicaid.ncdhhs.gov/blog/2026/07/10/transition-american-medical-association-maternity-current-procedural-terminology-2027-code-changesverified 2026-09-07	“Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule and the new maternity billing codes, released by the American Medical Association (AMA), will become effective as of this date.”
Some plans in directory 1/17 plans published	Michigan Medicaid (MDHHS)	Medicaid (provider alert to all providers)	<= 12/31/2026 (DOS)	Any	Any	Routine maternity	All	Adhere to current MDHHS Medicaid Provider Manual policy (global codes)	Current global codes per manual	not provided	not provided	not provided	not provided	not provided	required	Provided	Alert 2026-07-15	current policy	not provided	September 2026 - policy bulletin for public comment	D06https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/medicaid-providers/medicaid-provider-alerts/all-alerts-and-updates/july-15-2026-maternity-care-servicesverified 2026-09-07	“For routine maternity care services provided on and before December 31, 2026, providers are required to adhere to current Medicaid policy as outlined within the MDHHS Medicaid Provider Manual”
Some plans in directory 1/17 plans published	Michigan Medicaid (MDHHS)	Medicaid (provider alert to all providers)	>= 1/1/2027 (DOS)	Any	Any	Routine antepartum / postpartum	All	Separate CPT reporting incl. E/M for routine antepartum and postpartum; policy bulletin for comment due September 2026	E/M and separate CPT codes (not enumerated)	not provided	not provided	not provided	Global maternity codes	not provided	will	Provided (bulletin pending)	Effective 1/1/2027	announced; operational details pending	not provided	September 2026 - policy bulletin for public comment	D06https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/medicaid-providers/medicaid-provider-alerts/all-alerts-and-updates/july-15-2026-maternity-care-servicesverified 2026-09-07	“MDHHS will transition to the reporting of separate CPT codes, including the use of evaluation and management (E/M) codes for routine antepartum and postpartum care, for all dates of service occurring on and after January 1, 2027.”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027 (and/or with visit date)	Any	Routine prenatal	Antepartum	E/M + TH; pregnancy-related O or Z ICD-10 on all prenatal visits; 0500F on initial prenatal visit	E/M 99202-99215, 99341-99350, 99417 (+0500F initial visit)	TH	Pregnancy-related O or Z ICD-10 on every prenatal visit	Required: 0500F on the initial prenatal visit ('initial prenatal visits must include the Category II CPT code 0500F')	59400, 59425, 59426, 59510, 59610, 59618 when service dates include >= 1/1/2027	not provided	directs (must)	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“directs all NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services to use the below for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	< 6/1/2026 (prenatal care established)	<= 12/31/2026 (implied by 'through December 31, 2026')	Any	Routine prenatal	All	Current billing guidance (global) applies through 12/31/2026	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	applies	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“For services provided to NYS Medicaid members who have established prenatal care prior to June 1, 2026, current billing guidance applies through December 31, 2026.”
Some plans in directory 1/2 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 1/1/2027 (DOS in span)	Any	Any	Any	All	Bundled/global codes unavailable; further Medicaid Update articles promised for 2027 codes	not provided	not provided	not provided	not provided	59400, 59425, 59426, 59510, 59610, 59618	not provided	will	Provided (deletions only; 2027 codes not provided)	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational (deletions) / pending (2027 codes)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D32https://health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htm#obstetricverified 2026-09-07	“Bundled/Global CPT codes that will be deleted and unavailable when service dates include dates on or after January 1, 2027”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027 (and/or with visit date)	Any	Routine prenatal	Antepartum	E/M + TH; pregnancy-related O or Z ICD-10 on all prenatal visits; 0500F on initial prenatal visit	E/M 99202-99215, 99341-99350, 99417 (+0500F initial visit)	TH	Pregnancy-related O or Z ICD-10 on every prenatal visit	Required: 0500F on the initial prenatal visit ('initial prenatal visits must include the Category II CPT code 0500F')	59400, 59425, 59426, 59510, 59610, 59618 when service dates include >= 1/1/2027	not provided	directs (must)	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“directs all NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services to use the below for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	< 6/1/2026 (prenatal care established)	<= 12/31/2026 (implied by 'through December 31, 2026')	Any	Routine prenatal	All	Current billing guidance (global) applies through 12/31/2026	Current global/bundled codes	not provided	not provided	not provided	not provided	not provided	applies	Provided	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“For services provided to NYS Medicaid members who have established prenatal care prior to June 1, 2026, current billing guidance applies through December 31, 2026.”
No plan in directory 0/10 plans published	NYS Medicaid (DOH)	Medicaid fee-for-service; Medicaid Managed Care plans must align by 6/1/2026 and fully implement by 1/1/2027	>= 1/1/2027 (DOS in span)	Any	Any	Any	All	Bundled/global codes unavailable; further Medicaid Update articles promised for 2027 codes	not provided	not provided	not provided	not provided	59400, 59425, 59426, 59510, 59610, 59618	not provided	will	Provided (deletions only; 2027 codes not provided)	Medicaid Update April 2026 (Vol. 42 No. 5), 'effective immediately'	operational (deletions) / pending (2027 codes)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	D07https://healthweb-back.health.ny.gov/health_care/medicaid/program/update/2026/no05_2026-04.htmverified 2026-09-07	“Bundled/Global CPT codes that will be deleted and unavailable when service dates include dates on or after January 1, 2027”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield (New York)	Medicaid (article tagged Medicaid; 'Medicaid coverage provided by Anthem Blue Cross and Blue Shield HP')	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	Use the restructured (2027) coding system for this cohort; refer to NYS Medicaid Update April 2026 (D32) for the E/M+TH / O-Z dx / 0500F detail - the Anthem article itself does NOT contain the E/M+TH wording	Restructured maternity codes per NYS Medicaid Update (not enumerated in article)	not provided in article (TH is in NYS Medicaid Update D32)	not provided in article (O/Z dx is in D32)	not provided	Global/bundled OB codes for 2027 service dates	not provided	directed (must)	Provided (by reference to D32)	Published 2026-06-01 (updated 06-18); effective 1/1/2027 restructuring	operational (defers to NYS Medicaid Update April 2026)	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	D10https://providernews.anthem.com/new-york/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30315verified 2026-09-07	“All NYS Medicaid-enrolled providers of antepartum, postpartum, labor and delivery services are directed to use the restructured coding system for services provided to individuals that initiate prenatal care on or after June 1, 2026, and/or have an estimated due date on or after January 1, 2027. Providers should refer to NYS Medicaid Update - April 2026 Volume 42 - Number 5 for additional billing guidance.”
In directory 1/1 plan published	Anthem Blue Cross and Blue Shield (New York)	Commercial / Medicare Advantage	Any	Any	Any	Any	All	Not addressed - article is Medicaid-specific	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	D10https://providernews.anthem.com/new-york/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30315verified 2026-09-07	not provided
In directory 5/5 plans published	Highmark Blue Cross Blue Shield of Western New York	MMC, HARP, CHPlus, Essential Plan ONLY ('specific to the MMC, HARP, CHPlus, and EP programs only')	>= 6/1/2026 (prenatal care initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	Use the restructured (2027) coding system for this cohort; refer to NYS Medicaid Update April 2026 (D32) for the E/M+TH / O-Z dx / 0500F detail - the Highmark article itself does NOT contain that wording	Restructured maternity codes per NYS Medicaid Update (not enumerated in article)	not provided in article (TH is in NYS Medicaid Update D32)	not provided in article (O/Z dx is in D32)	not provided	Global/bundled OB codes for 2027 service dates	not provided	directs (must)	Provided (by reference to D32)	Published 2026-06-01 (updated 06-18)	operational (defers to NYS Medicaid Update)	Provider Services 1-866-231-0847	not provided	D26https://providernews.mybcbswny.com/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30316verified 2026-09-07	“this information is specific to the MMC, HARP, CHPlus, and EP programs only”
In directory 5/5 plans published	Highmark Blue Cross Blue Shield of Western New York / Northeastern New York	Commercial / Medicare Advantage	Any	Any	Any	Any	All	Not addressed - see Highmark enterprise awareness notice (D23)	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not addressed in source	Provider Services 1-866-231-0847	not provided	D26https://providernews.mybcbswny.com/articles/2027-maternity-care-coding-restructuring-allows-for-more-det-30316verified 2026-09-07	not provided
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	>= 6/1/2026 (routine prenatal visits initiated) and/or	>= 1/1/2027	Any	Routine prenatal	Antepartum	E/M + TH with pregnancy-related O or Z ICD-10; do not rely on bundled antepartum/global codes for 2027 DOS	Appropriate E/M	TH	Pregnancy-related O or Z ICD-10	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	Bundled antepartum / global codes for DOS >= 1/1/2027	not provided	must	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational (reimbursement policy)	not provided (refers to provider contract)	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Healthfirst providers must follow updated prenatal billing requirements for: Routine prenatal visits initiated on or after June 1, 2026 and/or Pregnancies with an estimated due date (EDD) on or after January 1, 2027.”
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	< 6/1/2026 (prenatal care began)	<= 12/31/2026	Any	Routine prenatal	All	Legacy global billing may apply if all global package requirements met by one provider/group	Global package codes	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	not provided	not provided	may	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Because prenatal care was initiated before June 1, 2026, and delivery occurs in 2026, the legacy global approach may still be used if the provider or provider group delivered all components of care.”
In directory 1/1 plan published	Healthfirst (New York)	CHP, Essential Plan, IB-Dual, MAP, MMC, QHP, HARP, Medicare Advantage	>= 1/1/2027 (DOS)	Any	Any	Any	Labor management / Delivery / Postpartum	Global package codes not recognized; labor management 59080-59083 separately reportable; new OB management codes introduced	59080, 59081, 59082, 59083 (labor management); new 2027 codes	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	Global obstetrical package codes	not provided	will	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“Global obstetrical package codes will no longer be recognized for reimbursement.”
In directory 1/1 plan published	Healthfirst (New York)	MMC and HARP only	Any	Any	Initial prenatal visit	Routine prenatal	Antepartum	Continue separate informational reporting of 0500F or 0503F (Category II)	0500F / 0503F	not provided	not provided	MMC and HARP only - required on separate informational claims (not reimbursed): 0500F (Initial Prenatal Visit), 0503F (Postpartum Visit); other products: not provided	not provided	not provided	must	Provided	PO-RE-132v4 effective 10/01/2025, last approval 05/18/2026; prenatal transition 6/1/2026	operational	not provided	not provided	D25https://hfproviders.org/documents/Reimbursement-Policy-PO-RE-132-Obstetric-Billing-Guidelines.pdfverified 2026-09-07	“For MMC and HARP, continue separate informational reporting of 0500F or 0503F.”
In directory 2/2 plans published	Independent Health (NY)	ALL products: Commercial, Medicare, State Programs, Self-Funded (applied 6/1/2026 to all products)	>= 6/1/2026 (antepartum care initiated) and/or	>= 1/1/2027 ('expected delivery date')	Any	Routine antepartum	Antepartum	Each prenatal visit as E/M + TH + pregnancy-related O/Z ICD-10; 0500F on initial antepartum visit; 59425/59426 denied	E/M (ex. 99202-99215) per visit + 0500F initial visit	TH	Pregnancy-related O or Z ICD-10	Required: 0500F on the initial antepartum visit claim ('Submit 0500F (Category II code) on the initial antepartum visit claim')	59425, 59426 (denied for members initiating care >= 6/1/2026)	not provided	must	Provided	SCOPE June 2026; effective 6/1/2026	operational	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	D29https://www.independenthealth.com/providers/whats-new/scope-newsletter/2026/june-2026verified 2026-09-07	“For members initiating antepartum care on or after June 1, 2026, antepartum care codes 59425 and 59426 will no longer be reimbursable for antepartum services; if submitted, the claim line will be denied.”
In directory 2/2 plans published	Independent Health (NY)	ALL products: Commercial, Medicare, State Programs, Self-Funded (applied 6/1/2026 to all products)	Any	Any	Any	Non-routine E/M outside routine antepartum care	Antepartum	Bill E/M without modifier TH	E/M	none (no TH)	not provided	not provided	TH on non-routine visits	not provided	must	Provided	SCOPE June 2026	operational	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	D29https://www.independenthealth.com/providers/whats-new/scope-newsletter/2026/june-2026verified 2026-09-07	“E/M visits outside of routine antepartum care are billed without Modifier TH”
Some plans in directory 1/2 plans published	Anthem Blue Cross (California)	Medi-Cal Managed Care ONLY	Any	Any	Any	Any	All	Bill antepartum, delivery and postpartum as individual services; global OB codes not reimbursed (unless contract/state/federal/CMS requires otherwise)	Individual antepartum / delivery / postpartum codes (not enumerated)	not provided	not provided	not provided	Global obstetrical codes	not provided	must	Provided	Policy G-14001 effective 10/23/2025 (individual-only rule since 08/07/2020)	current policy; no CPT 2027 content	not provided	not provided	D08https://providers.anthem.com/docs/gpp/california-provider/CA_CAID_RP_maternity_services.pdf?v=202606161403verified 2026-09-07	“Providers must bill antepartum care, deliveries, and postpartum care as individual services.”
No plan in directory	Anthem Blue Cross (California)	Commercial ONLY	Any	Any	Any	Any	All	Global OB code once per pregnancy when one provider/TIN furnishes all antepartum, delivery and postpartum care; otherwise bill only the components provided	Global obstetrical codes (e.g. 59400, 59510) or component codes	not provided	not provided	not provided	Global code when the provider/TIN did not furnish all components	not provided	allows	Provided	Policy C-19004 last approved 10/01/2025, effective 01/01/2026	current policy; no CPT 2027 content (references CPT 2024)	not provided	not provided	D38https://www.anthem.com/content/dam/digital/docs/anthembluecross/provider/commercial/policy/reimb/C-19004-CA.pdfverified 2026-09-07	“If a provider or provider group reporting under the same TIN does not provide all antepartum, delivery and postpartum services, global obstetrical codes may not be used.”
No plan in directory	Anthem Blue Cross (California)	Medicare Advantage ONLY	Any	Any	Any	Any	All	Global OB code once per pregnancy (279 days) when one provider/TIN furnishes all components; otherwise bill components	Global obstetrical codes or component codes	not provided	not provided	not provided	Global code when care is split across TINs	not provided	allows	Provided	Policy G-14001 last approved/effective 10/23/2025	current policy; no CPT 2027 content	not provided	not provided	D39https://www.anthem.com/content/dam/digital/docs/provider/commercial/policy/reimb/75978mupenmub.pdfverified 2026-09-07	“The health plan allows reimbursement for global obstetrical codes once per period of a pregnancy (defined as 279 days) when appropriately billed by a single provider or provider group reporting under the same federal Tax Identification Number (TIN)”
Some plans in directory 1/2 plans published	Anthem Blue Cross (California)	Medi-Cal Managed Care	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D08https://providers.anthem.com/docs/gpp/california-provider/CA_CAID_RP_maternity_services.pdf?v=202606161403verified 2026-09-07	not provided
No plan in directory	Anthem Blue Cross (California)	Commercial	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D38https://www.anthem.com/content/dam/digital/docs/anthembluecross/provider/commercial/policy/reimb/C-19004-CA.pdfverified 2026-09-07	not provided
No plan in directory	Anthem Blue Cross (California)	Medicare Advantage	>= 1/1/2027 (DOS)	Any	Any	Any	All	No CPT 2027 transition instruction found in this policy or in Anthem California Provider News (searched 2026-09-07: maternity, obstetric, 59400, CPT 2027) - absence of a located notice is not proof none exists	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	not found	not provided	not provided	D39https://www.anthem.com/content/dam/digital/docs/provider/commercial/policy/reimb/75978mupenmub.pdfverified 2026-09-07	not provided
Some plans in directory 1/2 plans published	MaineCare (Maine DHHS OMS)	Medicaid	before 9/1/2026 (act 'no later than prior to September 1, 2026')	Used as the trigger: bill by EDD and anticipated remaining antepartum visits	Per AMA Antepartum Transition Reporting guidance	Routine prenatal / postpartum	Antepartum / Postpartum	Move from global/bundled codes to E/M based on EDD and anticipated remaining visits; TH on ALL maternity E/M; each visit documented independently; maternity dx codes on all claims	E/M codes	TH on all maternity care E/M	Maternity-related diagnosis codes on all claims	not provided	Global / bundled service codes (per transition)	not provided	directing (must)	Provided (visit-count thresholds delegated to AMA guidance)	Bulletin: effective September 1, 2026	operational	Provider Relations Specialist (no number in notice); Maine DHHS (207) 287-3707	not provided	D09https://www.maine.gov/dhhs/oms/providers/provider-bulletins/addition-th-modifier-support-national-maternity-care-coding-and-reimbursement-changesverified 2026-09-07	“Adjust maternity care visit billing from global or bundled service codes to Evaluation and Management (E/M) service codes based on each member's estimated due date and the anticipated number of visits for the remainder of their antepartum period in accordance with AMA Antepartum Transition Reporting guidance”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	<= 5/15/2026 (initial prenatal visit)	Any	Any	Initial prenatal (confirmation of pregnancy)	All	Global obstetric codes may still be used	Global OB codes	not provided	not provided	not provided	not provided	not provided	recommends (may)	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“Until May 15, 2026 - Global obstetric codes still may be used”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	5/15/2026 - 7/14/2026 (initial prenatal visit)	Any	Any	Initial prenatal	Antepartum + Delivery	59426 + delivery-only code	59426 + delivery only	not provided	not provided	not provided	Global OB codes	not provided	recommends	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“May 15, 2026 - July 14, 2026 - Use CPT code 59426 + delivery only”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	7/15/2026 - 9/1/2026 (initial prenatal visit)	Any	Any	Initial prenatal	Antepartum + Delivery	59425 + delivery-only code	59425 + delivery only	not provided	not provided	not provided	Global OB codes	not provided	recommends	Provided	Recommended 2026 guidelines ahead of 1/1/2027	operational (recommended)	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“July 15, 2026 - September 1, 2026 - Use CPT code 59425 + delivery”
Some plans in directory 1/2 plans published	Arkansas Blue Cross and Blue Shield	not stated (members of Arkansas Blue Cross)	>= 9/1/2026 (initial prenatal visit)	Any	Any	Initial prenatal	All	Further guidance to be provided	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	Recommended 2026 guidelines ahead of 1/1/2027	pending	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	D11https://assets.contentstack.io/v3/assets/blte81730ee65c02059/bltdc4f1b5bbc2feaef/maternity-services-coding-changes.pdfverified 2026-09-07	“Arkansas Blue Cross will provide further guidance on recommended billing practices for initial prenatal visits for confirmation of pregnancy that occur on or after September 1, 2026.”
No plan in directory 0/3 plans published	TennCare (Tennessee Medicaid)	TennCare Episodes of Care - Perinatal episode	Any	Any	Any	Any	All	No billing/workflow change - perinatal episode performance pause for 2027 only (not a coding instruction)	not provided	not provided	not provided	not provided	not provided	not provided	n/a	Not provided (source is not a billing instruction)	Memo 2026-08-21	not a billing instruction	contracted MCO's provider relations team	not provided	D12https://www.tn.gov/content/dam/tn/tenncare/documents2/TemporaryPausePerinatalPerformance.pdfverified 2026-09-07	“Are providers required to change any workflows? No. Clinical workflows and patient care processes remain the same.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	< 9/1/2026 (first prenatal visit after confirmation)	Any	4-6 / 7+	Routine prenatal	Antepartum	Continue 59425 (4-6 visits) / 59426 (7+ visits)	59425, 59426	not provided	not provided	not provided	not provided	not provided	should	Provided	All Provider Bulletin 419, August 2026; guidance effective 9/1/2026	operational	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“For services rendered to patients whose first prenatal visit following confirmation of pregnancy occurred before September 1, 2026, providers should continue to bill using CPT code 59425 (Antepartum care only; 4- 6 visits) and CPT code 59426 (Antepartum care only; 7 or more visits), when applicable.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	>= 9/1/2026 (first prenatal visit after confirmation)	Any	Any	Routine prenatal	Antepartum	May report setting-appropriate E/M + TH (office 99202-99205/99211-99215; hospital 99221-99236; telemedicine 98000-98015)	99202-99215, 99221-99236, 98000-98015	TH	not provided	not provided	not provided	not provided	may	Provided	Effective 9/1/2026	operational (permissive)	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“For services rendered to patients whose first prenatal visit following confirmation of pregnancy occurred on or after September 1, 2026, providers may report services using the appropriate evaluation and management (E/M) code with modifier TH to indicate the visit is related to prenatal care.”
Some plans in directory 1/4 plans published	MassHealth	All providers participating in MassHealth	>= 1/1/2027 (DOS)	Any	Any	Any	All	Additional 2027 guidance planned	not provided	not provided	not provided	not provided	AMA-deleted global codes (59050 59400 59409 59410 59425 59426 59430 59510 59514 59415 59525 59610 59612 59614 59618 59620 59622)	not provided	not provided	Not provided	not provided	pending	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	D13https://www.mass.gov/doc/all-provider-bulletin-419-transition-to-separate-reporting-of-maternity-care-services/downloadverified 2026-09-07	“MassHealth plans to provide additional billing guidance in 2027 for the AMA 2027 Maternity Services Coding Structure.”
Some plans in directory 1/2 plans published	Blue Cross and Blue Shield of Texas	Professional (RP044)	Any	Any	Any	Any	All	Current global OB package rules (RP044); no 2027 instruction	Global OB package per RP044	not provided	not provided	Encouraged, not required (quality measurement only; no effect on reimbursement): 0500F or 0501F with the initial visit; 0503F with the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	Approved 5/15/2026, effective 5/22/2026	current policy; no CPT 2027 content	not provided	not provided	D14https://www.bcbstx.com/docs/provider/tx/standards/clinical-pay-coding/2026/rp044-5-22-2026.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	1-3 visits	Antepartum only (split care)	Antepartum	E&M codes	E&M	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	Reference guide (undated)	current policy; no CPT 2027 content	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 1-3 visits Use E&M Codes”
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	4-6 visits	Antepartum only	Antepartum	59425	59425	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 4-6 visits 59425”
In directory 1/1 plan published	Blue Cross and Blue Shield of Alabama	not stated	Any	Any	7+ visits	Antepartum only	Antepartum	59426	59426	not provided	not provided	Required on claims outside the global claim: 0500F (Initial prenatal care visit) or 0501F (Prenatal flow sheet) for the first prenatal visit; 0503F (postpartum care visit) with ICD-10 Z39.2 for the postpartum visit	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy	not provided	not provided	D19https://providers.bcbsal.org/portal/documents/10226/306297/Obstetrics%2BCoding%2Band%2BDocumentation%2BReference%2BGuide/8f5f1b65-1fd2-49a5-8708-6819a162098everified 2026-09-07	“Antepartum Care Only 7 or more visits 59426”
Some plans in directory 3/7 plans published	CareFirst BlueCross BlueShield	per Provider Manual Ch. 9	Any	Any	Any	Any	All	Global obstetrical package per medical policy 4.01.006A; no 2027 instruction	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Provided (reference only)	not provided	current policy; no CPT 2027 content	gender.services@carefirst.com is the only contact in the chapter (unrelated program)	not provided	D21https://provider.carefirst.com/carefirst-resources/provider/pdf/provider-manual-chapter-9-policies-procedures.pdfverified 2026-09-07	not provided
Some plans in directory 8/10 plans published	UnitedHealthcare	All UnitedHealthcare Commercial benefit plans (and Individual Exchange)	Any	Any	Any	Any	All	Current global OB package rules (2026R0064A); no 2027 instruction	Global OB package	not provided	not provided	not provided	not provided	not provided	not provided	Provided (current policy only)	2026R0064A	current policy; no CPT 2027 content	not provided	not provided	D27https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Obstetrical-Policy.pdfverified 2026-09-07	not provided
Some plans in directory 1/3 plans published	Medi-Cal (California DHCS)	Medi-Cal fee-for-service provider manual	Any	Any	Any	Any	All	Global billing 59400/59510/59610/59618 with pregnancy diagnosis; no 2027 instruction	59400, 59510, 59610, 59618	not provided	Pregnancy diagnosis required	not provided	not provided	not provided	not provided	Provided (current policy only)	Manual page updated January 2026	current policy; no CPT 2027 content	not provided	not provided	D31https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/F01FC605-49CD-4474-827D-CEEEB7EF02C3/pregglo.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULOverified 2026-09-07	not provided
In directory 1/1 plan published	TRICARE (DHA)	TRICARE (Reimbursement Manual TR15 Ch.1 Sec.18)	Any	Any	Any	Any	All	All-inclusive global maternity fee (59400/59510) when one provider furnishes all segments; separate billing when care is split	59400, 59510 or component codes	not provided	not provided	not provided	not provided	not provided	not provided	Provided (current policy only)	not provided	current policy; no CPT 2027 content	not provided	not provided	D36https://manuals.dha.mil/View-Publication/TR15/FileName/C1S18?referenceDate=2024-05-07verified 2026-09-07	not provided
Some plans in directory 17/18 plans published	Centene (corporate template CC.PP.016)	Adopting health plans, each on its own effective date ('Health Plan means a health plan that has adopted this payment policy')	Any	Any	Any	Any	All	Global maternity package reporting and prepayment code review; no 2027 instruction; adoption by any specific plan not verified	Global maternity package	not provided	not provided	not provided	not provided	not provided	not provided	Provided (template; plan adoption not provided)	effective as of the date determined by Health Plan	current policy template; no CPT 2027 content	not provided	not provided	D01https://www.centene.com/content/dam/centene/policies/payment-policies/CC.PP.016.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	not stated	>= 9/1/2026 (DOS)	Any	Any	First prenatal visit after confirmation and subsequent antepartum visits	Antepartum	Must bill E/M + TH + Z34.XX or O00-O9A	Appropriate E/M	TH	Z34.XX or O00-O9A	not provided	59425/59426 for these DOS (implied)	not provided	must	Provided	August 2026 notification (updated 7/30/2026), effective 09/01/2026	operational	not provided	not provided	D15https://www.bluecrossvt.org/documents/august-2026-changes-maternity-care-services-coding-and-billing-notice-publicationverified 2026-09-07	“beginning on and for dates of service on or after September 1, 2026, claims for the first prenatal visit after confirmation of pregnancy and subsequent antepartum visits must be billed with: An appropriate E/M code appended with modifier -TH to differentiate the visits as maternity care, and An appropriate ICD-10-CM code Z34.XX to verify the gestation of the pregnancy or with an appropriate pregnancy diagnosis code O00-O9A.”
In directory 1/1 plan published	Blue Cross and Blue Shield of Vermont	not stated	<= 8/31/2026 (DOS)	Any	4-6 / 7+ or E/M	Prenatal	Antepartum	Appropriate E/M or 59425 (4-6) / 59426 (7+)	E/M or 59425/59426	not provided	not provided	not provided	not provided	not provided	should	Provided	August 2026 notification	operational	not provided	not provided	D15https://www.bluecrossvt.org/documents/august-2026-changes-maternity-care-services-coding-and-billing-notice-publicationverified 2026-09-07	“Claims for prenatal care for dates of services on or before August 31, 2026, should be billed with the appropriate E/M code or the current antepartum codes 59425 (4-6 visits) or 59426 (7 or more visits).”
No plan in directory 0/1 plan published	Blue Cross and Blue Shield of Vermont	not stated	>= 9/1/2026	Any	Any	First prenatal visit after confirmation	Antepartum	SUPERSEDED by August 2026 edition (D15): June edition required E/M + TH + Z3A	E/M	TH	Z3A (June edition; replaced by Z34.XX/O00-O9A in August edition)	not provided	not provided	not provided	must	Provided (superseded)	June 2026 edition, effective 9/1/2026	replaced	not provided	not provided	D16https://www.bluecrossvt.org/documents/june-2026-global-maternity-coding-changes-notificationverified 2026-09-07	not provided
Some plans in directory 1/2 plans published	Blue Cross NC	not stated	>= 1/1/2027 (services performed)	Any	Any	Any	All	Aligning with AMA; providers 'will need to make changes ... beginning mid-May 2026'; no billing instruction; additional guidance to be shared	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	News 2026-05-26	awareness only	not provided	'coming months' (from 2026-04); billing changes begin mid-May 2026	D17https://www.bcbsnc.com/providers/provider-news/2026/changes-to-billing-for-global-maternity-services-effective-1-1-27verified 2026-09-07	“providers will need to make changes ... beginning mid-May 2026 to support accurate reimbursement of services performed on or after January 1, 2027”
In directory 1/1 plan published	Community First Health Plans (TX)	Medicaid/CHIP site ('advance awareness communication')	>= 1/1/2027	Any	Any	Any	All	Lists 2027 CPT changes (59080-59083, 59431/59432/59502/59503); implementation and reimbursement details to follow	2027 codes listed for awareness only	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	Notice 2026-08-03	awareness only	Provider Relations ProviderRelations@cfhp.com, 210-358-6030	No date - 'as more information becomes available'	D22https://medicaid.communityfirsthealthplans.com/2026/08/03/important-notice-2027-maternity-care-coding-updates/verified 2026-09-07	“advance awareness communication”
Some plans in directory 13/22 plans published	Highmark (Highmark BS CPA/SEPA, BCBS DE, BS NENY, BCBS WNY, BCBS WPA/NEPA, BCBS WV)	Professional and facility providers, all listed regions	Any	Any	Any	Any	All	Highmark 'is conducting a comprehensive review'; will formally notify of changes; no billing instruction	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	News 2026-07-01	awareness only	not provided	No date - 'will formally notify you of any changes'	D23https://providers.highmark.com/communications-hub/news-and-updates/maternity-billing-changes-for-2027.htmlverified 2026-09-07	“is conducting a comprehensive review”
In directory 2/2 plans published	Geisinger Health Plan	All GHP plan offerings ('apply consistently across all GHP plan offerings')	Any (until formally notified)	Any	Any	Any	All	Continue billing maternity services as you do today until formally notified; grace periods promised (no dates)	Current codes	not provided	not provided	not provided	not provided	not provided	continue	Provided (hold instruction)	Update 2026-05-15	awareness / hold	Claims: 844-GHP-PROV (844-447-7768)	No date - operational details, billing guidance, educational resources 'as implementation planning continues'	D24https://www.geisinger.org/health-plan/providers/updates/search-updates/2026/05/27/16/01/maternity-cpt-coding-modernizationverified 2026-09-07	“Until you are formally notified by GHP, continue billing maternity services as you do today”
Some plans in directory 1/7 plans published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	<= 12/31/2026 (DOS)	Any	Any	Any	All	Current global codes and current modifier requirements remain; no early itemized transition (HCA will NOT follow ACOG September 2026 approach); no proration	Current global OB codes; 0500F first prenatal visit	Current modifier requirements through 12/31/2026	not provided	Required: 0500F on the first prenatal visit ('Providers must continue submitting CPT code 0500F to identify the first prenatal visit'; HEDIS Timeliness of Prenatal Care; pays zero)	Itemized E/M in lieu of global before 1/1/2027 (not adopted)	0500F pays $0 (billed at $0.01)	will not (no early transition)	Provided	FAQ June 2026	operational (hold)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-09-07	“HCA does not plan to: Follow American College of Obstetricians and Gynecologists' (ACOG) recommendation for September 2026 implementation to itemized billing. Prorate payments for global OB codes.”
Some plans in directory 1/7 plans published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	>= 1/1/2027 (DOS)	Any	Any	First prenatal visit	Antepartum	Bill appropriate E/M (reimbursable) + 0500F (pays zero); deleted global codes removed from billing guides; cross-year and modifier guidance to be published	E/M + 0500F	pending ('HCA will provide updated modifier guidance')	Pregnancy-related primary diagnosis identifies pregnancy E/M	Required: 0500F on the first prenatal visit ('Providers must continue submitting CPT code 0500F to identify the first prenatal visit'; HEDIS Timeliness of Prenatal Care; pays zero)	Deleted global obstetrics codes	0500F pays zero	should	Provided (partial; cross-year/modifier guidance pending)	Effective 1/1/2027	operational (partial)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-09-07	“Effective January 1, 2027: The first prenatal visit should be billed with the appropriate Evaluation and Management (E/M) code and CPT 0500F. The E/M code will be reimbursable. CPT 0500F will continue to pay zero.”
Some plans in directory 1/7 plans published	Washington Apple Health (HCA)	Medicaid fee-for-service (FAQ also asserts 'all providers and payors' transition 1/1/2027)	Care spans 2026 -> 2027	>= 1/1/2027	Any	Any	All	Guidance to be published in Pregnancy-related services and Planned home births billing guides	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	pending	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	D18https://www.hca.wa.gov/assets/billers-and-providers/pregnancy-related-billing-codes-faq.pdfverified 2026-09-07	“HCA will publish guidance for clients whose pregnancy care spans 2026 and 2027.”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Antepartum	Individual codes per date of service; global/prenatal-bundle codes rejected (code 272)	Prenatal: 99202-99205, 99211-99215, 99242-99245, 99457, 99458, 99483	not provided	not provided	not provided	59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622, 59425, 59426, H1005	not provided	must	Provided	Revised July 2026; DOS after March 1, 2026	operational (current policy; no CPT 2027 content)	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Providers must bill for maternity services claims using individual service codes rather than global maternity codes that bundle multiple services.”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Delivery	Delivery-only codes	59409, 59620, 59612, 59514	not provided	not provided	not provided	Global delivery+care codes	not provided	must	Provided	Revised July 2026	operational	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Delivery 59409 Vaginal delivery only ... 59620 ... 59612 ... 59514 Cesarean delivery only without postpartum care.”
In directory 1/1 plan published	Molina Healthcare of Florida	Medicaid and Marketplace	> 3/1/2026 (DOS)	Any	Any	Any	Postpartum	Postpartum individual codes	57170, 58300, 59430, 99202-99205, 99211-99215	not provided	not provided	not provided	Postpartum bundled codes	not provided	must	Provided	Revised July 2026	operational	Provider Relations Representative or Provider Services (855) 322-4076	not provided	D34https://www.molinahealthcare.com/providers/fl/medicaid/comm/-/media/C302F43FFF3743E3A5F7A2642D6C46B2.ashxverified 2026-09-07	“Postpartum Care CPT: 57170, 58300, 59430, 99202-99205, 99211-99215”
In directory 57/57 plans published	CMS Medicare (Physician Fee Schedule) - all Part B MACs	Medicare Part B	>= 1/1/2027 (CY 2027)	Any	Any	Any	All	PROPOSED only: value new CPT maternity codes AND seek comment on 15 G-codes mirroring the global structure 'in lieu of adoption of the new CPT codes' - not final; no billing instruction yet	not provided	not provided	not provided	not provided	not provided	not provided	proposed	Not provided (proposed rule)	Federal Register 2026-07-16 (proposed)	proposed rule	MedicarePhysicianFeeSchedule@cms.hhs.gov; claims questions to the Medicare Administrative Contractor	Comment period ends 2026-09-14; CY 2027 PFS final rule (CMS-1848-P) to follow	D33https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-otherverified 2026-09-07	“in lieu of adoption of the new CPT codes for purposes of Medicare payment”
No plan in directory 0/2 plans published	BlueCross BlueShield of Tennessee	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Cited July 2026 BlueAlert could not be retrieved - rolling URL serves the September 2026 issue with no maternity article	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Provider Network Manager (generic BlueAlert footer)	not provided	D20https://content.bcbst.com/api/public/content/prov-bluealert.pdfverified 2026-09-07	not provided
In directory 9/9 plans published	Humana	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Claims payment policies index contains no maternity/obstetric policy	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	not provided	not provided	D28https://provider.humana.com/coverage-claims/claims-payment-policiesverified 2026-09-07	not provided
Some plans in directory 1/2 plans published	Kaiser Permanente Northern California	HMO provider manual	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Manual text contains no maternity/obstetric/global billing section	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Medical Services Contracting (925) 924-5050	not provided	D30https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/ever/hmo-provider-manual-en.pdfverified 2026-09-07	not provided
In directory 1/1 plan published	Oscar Health	Individual & Family / Small Group (member benefits page)	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Member coverage page, not a provider billing policy	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	Member Care Team 1-855-672-2755 (member line, not provider)	not provided	D35https://www.hioscar.com/maternityverified 2026-09-07	not provided
In directory 1/1 plan published	UMR	not stated	Any	Any	Any	Any	All	REVIEW FAILED / NOT A POLICY: Generic claim-submission page; no maternity content	not provided	not provided	not provided	not provided	not provided	not provided	not provided	Not provided	not provided	unverifiable / not a billing policy	not provided	not provided	D37https://www.umr.com/provider/Claimsubmissionsverified 2026-09-07	not provided

Payer contacts and promised follow-up guidance

Verbatim from each source; “not provided” when the document names no provider-facing contact or no follow-up date.

Source	Payer	Payer contact	Further guidance promised	Source wording
D02	Aetna	not provided in the maternity article (general OfficeLink contacts only)	No date - 'stay tuned'; implementation details 'still to come'	“Stay tuned for future communications as additional coding, valuation, reimbursement and fee schedule information becomes available.”
D03	Aetna Better Health of Florida	not provided	No date - coding guidance and claims-editing rules 'expected but not yet finalized'	“Additional coding guidance and claims-editing rules are expected but were not yet finalized at the time of early release.”
D04	Cigna Healthcare	AMAMaternityCodes@CignaHealthcare.com	'later this year' (2026) - additional 2027 billing guidance	“We will continue to monitor industry developments and provide additional 2027 billing guidance later this year.”
D05	NC Medicaid (NCDHHS)	NC Medicaid Contact Center 888-245-0179	No date - Clinical Coverage Policy 1E-5 'is being revised'	“Clinical Coverage 1E-5 is being revised to reflect the updated information.”
D06	Michigan Medicaid (MDHHS)	not provided	September 2026 - policy bulletin for public comment	“A policy bulletin will be published for public comment in September reflecting coding updates for routine maternity care services furnished on and after January 1, 2027.”
D07	NYS Medicaid (DOH)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	“Further guidance will be released by the AMA for obstetric-related services, and the NYS Department of Health will release further Medicaid Update articles.”
D09	MaineCare (Maine DHHS OMS)	Provider Relations Specialist (no number in notice); Maine DHHS (207) 287-3707	not provided	—
D10	Anthem Blue Cross and Blue Shield (New York)	Provider Services 800-450-8753	No date - defers to NYS Medicaid Update April 2026	“Providers should refer to NYS Medicaid Update - April 2026 Volume 42 - Number 5 for additional billing guidance.”
D11	Arkansas Blue Cross and Blue Shield	designated Arkansas Blue Cross Network Development Representative	No date - further guidance for initial prenatal visits on/after 9/1/2026	“Arkansas Blue Cross will provide further guidance on recommended billing practices for initial prenatal visits for confirmation of pregnancy that occur on or after September 1, 2026.”
D12	TennCare (Tennessee Medicaid)	contracted MCO's provider relations team	not provided	—
D13	MassHealth	Provider questions (800) 841-2900, TDD/TTY 711, provider@masshealthquestions.com	2027 - additional billing guidance	“MassHealth plans to provide additional billing guidance in 2027 for the AMA 2027 Maternity Services Coding Structure.”
D17	Blue Cross NC	not provided	'coming months' (from 2026-04); billing changes begin mid-May 2026	“Additional guidance and resources will be shared in the coming months.”
D18	Washington Apple Health (HCA)	not provided	No date - guidance for care spanning 2026/2027, modifier guidance, FAQ updates and webinars	“HCA will publish guidance for clients whose pregnancy care spans 2026 and 2027.”
D20	BlueCross BlueShield of Tennessee	Provider Network Manager (generic BlueAlert footer)	not provided	—
D21	CareFirst BlueCross BlueShield	gender.services@carefirst.com is the only contact in the chapter (unrelated program)	not provided	—
D22	Community First Health Plans (TX)	Provider Relations ProviderRelations@cfhp.com, 210-358-6030	No date - 'as more information becomes available'	“Community First is currently reviewing these revisions and will provide additional guidance as more information becomes available.”
D23	Highmark (Highmark BS CPA/SEPA, BCBS DE, BS NENY, BCBS WNY, BCBS WPA/NEPA, BCBS WV)	not provided	No date - 'will formally notify you of any changes'	“We will formally notify you of any changes that may affect your claim submissions for Highmark members.”
D24	Geisinger Health Plan	Claims: 844-GHP-PROV (844-447-7768)	No date - operational details, billing guidance, educational resources 'as implementation planning continues'	“Additional communications will be shared as implementation planning continues, including operational details, billing guidance, and educational resources.”
D25	Healthfirst (New York)	not provided (refers to provider contract)	not provided	—
D26	Highmark Blue Cross Blue Shield of Western New York	Provider Services 1-866-231-0847	not provided	—
D29	Independent Health (NY)	Provider Relations (716) 631-3282 or 1-800-736-5771, Mon-Fri 8-5	2026-06-01 - reimbursement manual section with billing examples on provider portal	“will have a section dedicated to this change within the Participating Provider Reimbursement Manual on your provider portal as of June 1, 2026”
D30	Kaiser Permanente Northern California	Medical Services Contracting (925) 924-5050	not provided	—
D32	NYS Medicaid (DOH)	FFS claims: eMedNY Call Center (800) 343-9000; FFS policy: MaternalandChild.HealthPolicy@health.ny.gov; MMC: the enrollee's MMC plan	No date - further Medicaid Update articles	“Further guidance will be released by the AMA for obstetric-related services, and the NYS Department of Health will release further Medicaid Update articles.”
D33	CMS Medicare (Physician Fee Schedule) - all Part B MACs	MedicarePhysicianFeeSchedule@cms.hhs.gov; claims questions to the Medicare Administrative Contractor	Comment period ends 2026-09-14; CY 2027 PFS final rule (CMS-1848-P) to follow	“This document has a comment period that ends in 9 days. (09/14/2026)”
D34	Molina Healthcare of Florida	Provider Relations Representative or Provider Services (855) 322-4076	not provided	—
D35	Oscar Health	Member Care Team 1-855-672-2755 (member line, not provider)	not provided	—

Evidence standard

How rows are produced

Rows are extracted document by document. A row is only linked to a plan when the document names that payer, program or product; the plans column is then resolved against the live policy directory, so plans the directory review removed or re-labelled are shown accordingly.

Guidance is “Provided” when the document states an operational billing instruction, “Provided (by reference)” when it defers to another named document, and “Not provided” or “Inferred” otherwise. Obligation preserves the payer's verb (must, should, may, encouraged).

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.