New Maternity Billing Codes Set to Change How Pregnancy Care is Charged Starting January
Starting in January, U.S. maternity care providers will shift from a single bundled billing code to itemized, fee-for-service codes covering pregnancy, childbirth, and postpartum care. The change, developed by the American College of Obstetricians & Gynecologists and the American Medical Association, is designed to better reflect the complexity of modern maternity care and compensate a wider range of providers. However, patient advocates and employer groups warn the shift could raise out-of-pocket costs, particularly for patients on high-deductible health plans.
Beginning in January, U.S. maternity care billing will transition from a single global bundled payment to itemized fee-for-service codes, a change championed by ACOG and the AMA to more accurately capture the varied and increasingly complex care that pregnant patients receive. The current bundled system sets a fixed number of 13 prenatal visits and uses one code regardless of labor length or delivery complexity, which ACOG argues fails to reflect modern obstetric practice. The new codes will allow for more or fewer visits, remote care, extended postpartum follow-up, and compensation for a broader range of providers including midwives, hospitalists, and maternal-fetal medicine specialists. Critics, including patient advocates and employer representatives, worry the shift back to fee-for-service will incentivize higher volumes of tests and more expensive providers, potentially driving up both out-of-pocket costs and insurance premiums. Medicaid enrollees, who account for about 41% of U.S. births, are largely shielded from direct cost increases, but commercially insured patients—especially those with high-deductible plans—face uncertainty. The insurance industry has also raised concerns about the rushed implementation timeline. CMS has not yet confirmed whether it will adopt the new codes, with its proposed fee schedule for next year expected in July.
What's missing
It is unclear whether any independent actuarial or health economics analysis has been conducted to estimate the likely magnitude of out-of-pocket cost increases for commercially insured patients under the new coding system. Additionally, the article does not address how other countries structure maternity billing or whether comparable fee-for-service transitions elsewhere have led to measurable cost or quality changes.
What different sources said
- Medical XpressCenter
Upcoming billing change could make pregnancy pricier
- KFF Health NewsCenter
Upcoming Billing Change Could Make Pregnancy Pricier
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