The AMA is introducing major updates to CPT® Maternity Care Services in 2027, shifting how antepartum, labor management, and postpartum care are reported. The biggest change is the move away from global maternity packages toward more accurate, visit‑based reporting. For those of us in Texas, much of this will feel familiar — we already bill prenatal visits individually with the TH modifier for Medicaid maternity related care. So while many states will experience a larger transition, Texas practices will mainly need to prepare for the new Labor Management codes, which are brand‑new for everyone.
How Practices Can Prepare
The AMA has provided clear instructions for patients whose antepartum care spans both 2026 and 2027. Here’s the simplified version:
- Antepartum visits completed in 2026 should be billed using 59425, 59426, or E/M codes, depending on the total number of visits in 2026.
- Antepartum visits completed in 2027 must be billed using E/M codes.
- CPT codes 59425 and 59426 remain active in the 2026 code set and may still be used under current guidelines.
- For fewer than 4 antepartum visits, E/M codes may be used — this guidance already exists in the current CPT code set.
- The correct code (59425 vs. 59426) depends on the exact number of antepartum encounters completed in 2026, which won’t be known until later in the year.
- Practices should begin identifying patients whose care will cross over into 2027 based on their anticipated delivery dates.
Our Recommendation for a Smooth Transition
- Continue using your current tracking method for commercial payor antepartum visits — such as by adding a pseudo or internal modifier to these visits — so you can easily identify patients whose care spans both years.
- Check with each payor to confirm whether they want prenatal visits billed now as individual E/M services, and whether they require the TH modifier for maternity related care.
- If a patient has more than 4 antepartum visits in 2026, confirm with the carrier whether you should bill 59425 or 59426 now under the current guidelines.
- Once payor guidance is confirmed, run a monthly report using your internal antepartum tracking modifier to monitor patients approaching the crossover period.
- At year‑end, bill:
- Individual E/M visits for 2026 services if less than 4 visits before the end of the year
- 59425 or 59426 for 2026 services if more than 4 visits were completed and the payor approves
- Prepare your team now for the new Labor Management codes, which will be the biggest operational change for Texas practices.
Final Thoughts
The AMA’s upcoming maternity care changes mark one of the most significant shifts OB practices have seen in years, but with early planning and clear workflows, the transition can be smooth and manageable. For many practices across the country, these updates will require major adjustments to how antepartum, labor, and postpartum services are documented and billed. But for those of us here in Texas, much of the antepartum billing structure already aligns with the new model — meaning our biggest focus will be preparing for the new Labor Management codes and ensuring our teams understand how to apply them correctly. We will address Labor Management in our next posting.
By continuing to track antepartum visits with your internal modifier, confirming payor expectations, and running monthly reports to identify crossover patients, your practice can stay ahead of the transition and avoid year‑end billing surprises. The key is to start now, communicate clearly with your payors, and make sure your providers, coders, and billers understand what will change — and what will stay the same.
If your team needs help preparing, training, or updating workflows, PPMC Academy is here to support you every step of the way.
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