New CPT coding conventions for prenatal care to take effect in 2027
Revenue cycle professionals should be gearing up for the upcoming changes to Current Procedural Terminology (CPT®) coding for maternity care services.
Beginning January 1, 2027, services for antepartum care, labor management, delivery, and postpartum care will be coded separately. The change moves away from the traditional global maternity care model toward a framework designed to better reflect how, when, where, and by whom obstetric care is delivered.
The update consists of 12 new codes, 17 deleted codes, and six revised codes. It also includes significant revisions to subsection guidelines and relocates some existing codes.
By definition, antepartum (prenatal) care encompasses all visits from the diagnosis of pregnancy to the onset of labor. Starting in 2027, these services will be coded with the appropriate evaluation and management (E/M) service code for each encounter. This approach will allow care to be reported based on the patient’s individual needs, medical co-morbidities, pregnancy complications, social determinants of health, and preferences rather than using the traditional one-size-fits-all model.
Prenatal services will be reported with the following CPT codes:
- Office or other outpatient services: 99202‒99205, 99211‒99215
- Home or residence services: 99341‒99345, 99347‒99350
- Initial or subsequent hospital inpatient or observation services: 99221‒99223, 99231‒99233
- Hospital inpatient or observation care services, including admission and discharge services: 99234–99236
- Critical care services: 99291, 99292
- Telemedicine services: 98000–98015
- Virtual check-in: 98016
Diagnostic and therapeutic procedures performed during this period will be reported in addition to E/M services when appropriate. Diagnostic imaging services, such as obstetrical ultrasound evaluation (76801–76828) and fetal magnetic resonance imaging (74712–74713), will also be separately reportable in addition to antepartum E/M visits when applicable.
CPT code 59050, which is used to report fetal monitoring during labor by a consulting physician, will be deleted, with instructions to document code 59051 for interpretation and report of fetal heart tracing. Consultations requested for evaluation of a pregnant patient and/or the fetus, outside of fetal heart monitoring, should be reported with the appropriate E/M codes.
Visits for other than obstetric or labor management provided on the same date of service as an obstetric visit by the same provider will require the addition of modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Services outside of normal obstetric care provided on the same calendar date should be supported by appropriate diagnosis coding, including diagnoses unrelated to the pregnancy when applicable, to demonstrate the medical necessity of the separate service.
Lastly, visits for surveillance of a high-risk pregnancy should include the appropriate diagnosis code to support medical necessity and frequency of care.
Editor’s note: This article includes reporting from Part B News.