How to prepare for the 2027 maternity coding changes

The 2027 transition starts before January 1

January 1, 2027, may be the effective date for the new maternity CPT® codes, but the starting line for practice readiness is much earlier. Because maternity care spans months, patients receiving prenatal care today may deliver after the new coding framework takes effect.

To help practices and payers prepare for that crossover, ACOG has recommended September 1, 2026, as a transition point for using E/M codes for patients beginning prenatal care, and many payers have communicated their own operational plans for moving to E/M billing. Practices should confirm transition policies with individual payers and continue monitoring current ACOG and AMA guidance as implementation approaches evolve.

That 2026-to-2027 crossover makes the transition an operational consideration now. Dr. Lisa Hofler is an advisor to the ACOG Committee on Health Economics and Coding, one of ACOG’s advisors to the American Medical Association (AMA) CPT® Editorial Panel, and a former member of the CPT Maternity Care Services Workgroup. In her conversation with athenahealth, she explained that practices relying on the global OB package need to think ahead about patients whose care crosses into 2027, including how services provided before the effective date will be documented, reported, and billed.

The AMA has released the 2027 maternity care codes and guidelines ahead of their effective date, giving physicians, payers, coders, and health technology organizations time to prepare. But readiness won’t look the same for every practice. Payer policies and transition approaches may vary, making it important to follow current guidance from the American College of Obstetricians and Gynecologists (ACOG), engage payers, and assess your own workflows now. In the meantime, practices should follow current ACOG and AMA guidance, engage their payers directly, and assess their own workflows and financial assumptions as more information becomes available.

Practices should be planning now for how clinical documentation, revenue cycle processes, payer requirements, and technology will come together as the global OB package gives way to the new model.

Start with the biggest workflow shift: Documentation

Moving away from the global OB package changes what practices need to capture as care occurs. Under the current global model, documentation supports the clinical record, but individual prenatal and postpartum encounters are generally included within the bundled service rather than reported separately. Beginning in 2027, antepartum and postpartum care will instead be reported at the encounter level using the appropriate evaluation and management (E/M) codes.

For clinicians, the underlying E/M principles are already familiar from other types of care, including gynecologic services and problem visits. The adjustment is applying them consistently to maternity care. "Prenatal visits are going to be documented and reported just like every other visit," Dr. Hofler explained. In practice, that means documentation will need to support the level of service based on medical decision making (MDM) or time, consistent with current E/M guidelines. The adjustment is applying them consistently to maternity care. "Prenatal visits are going to be documented and reported just like every other visit," Dr. Hofler explained. In practice, that means documentation will need to support the level of service based on medical decision making (MDM) or time, consistent with current E/M guidelines.

That shift makes it important for practices to examine whether today's maternity documentation captures the work clinicians are already doing at each encounter. For providers with consistent, thorough documentation habits, existing workflows may already capture much of the information needed to support medical decision making (MDM) and E/M billing. Others may identify opportunities to make that work more explicit in the record.

A prenatal visit may involve assessing changes in the pregnancy, managing existing conditions, reviewing test results, counseling the patient, or adjusting the care plan. Under an encounter-based model, the record needs to reflect that work clearly enough to support appropriate coding.

The goal shouldn't be to add documentation for documentation's sake. It's to create workflows that accurately capture the care being delivered without creating unnecessary administrative complexity. For practices preparing for 2027, that makes documentation readiness both a coding consideration and a clinical workflow priority. athenaOne® for Women's Health already supports E/M billing workflows, with the OB Worksheet embedded into encounter, accelerators and AI-powered solutions that can help create a more comprehensive documentation experience. Together, these capabilities can help clinicians capture the information needed to support care and billing as maternity reimbursement moves toward an encounter-based model.

Look beyond prenatal visits

While antepartum E/M documentation may be one of the most immediate workflow changes, it's only one part of the transition. The new maternity coding framework separates care across four phases:

• Antepartum care
• Labor management
• Delivery
• Postpartum care

As a result, practices will need to look beyond the office visit and consider how care is documented and captured across the entire maternity journey.

Under the new framework, labor management is reported by calendar date, with distinctions between initial and subsequent days and between straightforward and complex care. Delivery is then reported separately from labor management, while postpartum care provided after the day of delivery is reported using the appropriate E/M code.

For practices accustomed to the global OB package, this transition creates new points in the workflow where documentation and reporting need to align. As Dr. Hofler explained, care that was previously encompassed within a single delivery code will become more visible: “Every day of labor management, that gets reported.”

The new framework creates greater visibility into the frequency, intensity, and complexity of maternity care. Capturing that care, however, requires coordination across settings and teams. Practices can map how care moves from prenatal visits through labor, delivery, and postpartum follow-up, identifying where documentation occurs, who is responsible for capturing it, and how that information reaches the revenue cycle.

Taking this practice-wide view now can help surface gaps before the new framework takes effect.

Make readiness a team effort

Maternity coding readiness isn't solely a coding or revenue cycle responsibility. The new framework connects clinical documentation, billing, payer requirements, operational workflows, and technology, making preparation a practice-wide effort and a great opportunity to partner with trusted vendors who want to help them succeed.

As Dr. Hofler noted, several functions will need to move in parallel. Clinical documentation, EHR workflows, revenue cycle processes, and evolving payer requirements all need to align.

For independent practices, where one person may oversee several of these functions, establishing responsibilities early may be especially important. Consider how each stakeholder will contribute to readiness:

• Clinicians: Understand how documentation expectations are changing and how E/M principles apply to maternity care.
• Coding and revenue cycle teams: Translate documentation into accurate claims and stay current on evolving payer policies.
• Practice administrators: Coordinate education, workflow changes, and financial planning.
• Clinical operations teams: Examine handoffs across prenatal care, labor and delivery, and postpartum care.
• Technology partners: Help incorporate new requirements into existing workflows while reducing what clinicians and staff need to manage manually.

A shared transition plan can help practices identify dependencies and gaps early and establish clear ownership for documentation, education, payer readiness, revenue cycle processes, and technology.

Let technology carry more of the cognitive load

Adapting to a new workflow takes attention, even when the underlying concepts are familiar. Dr. Hofler compared the transition to learning to drive. At first, every step requires conscious thought. With the right systems and repetition, those steps eventually become routine.

Technology can help make new requirements part of the everyday process. As maternity coding workflows evolve, technology can help fit new requirements into the way clinicians and staff already work, support consistent documentation, and connect clinical activity with downstream revenue cycle processes. Just as importantly, well-designed workflows can reduce how much clinicians and staff must remember and manage on their own.

That's where the collaboration between athenahealth and ACOG can help bridge guidance and implementation. ACOG brings clinical and coding expertise and educational guidance, while athenahealth is working to ensure athenaOne for Women's Health supports practices as they navigate the transition.

The goal is to make the right workflow easier to follow, reducing administrative friction while helping practices accurately capture the care their teams provide.

Build your transition plan now

The move away from the global OB package changes where and how maternity care becomes visible across the practice. Preparing for that shift means connecting the clinical encounter with the documentation, revenue cycle, payer, and technology workflows that support it.

Start with what your practice can control: understand where the global OB package touches your workflows today, assess whether documentation captures care at the level the new framework will require, identify dependencies across clinical and revenue cycle teams, and establish clear ownership for transition planning. As guidance evolves, resources from ACOG can help practices stay current and refine their approach.

The opportunity is bigger than preparing for a new coding framework. With the right plan, practices can build workflows that more accurately reflect the care their teams provide while minimizing unnecessary administrative complexity.

Explore ACOG’s Coding and Billing resource, including Payment for Obstetric Services, coding courses, and Clinical Coding on Demand.

Already an athenahealth customer? Connect with your Customer Success Manager to discuss how your practice can prepare for the 2027 maternity coding transition.

If you’re considering athenaOne for Women’s Health, request a demo to learn about connected clinical, revenue cycle, and practice workflow support for OB-GYN practices.

Continue the conversation at Thrive 2026. ACOG and AMA experts will join athenahealth at Thrive to help customers better understand the 2027 maternity coding changes and prepare their practices for the transition. Learn more about this year’s summit.