New Maternity Billing Codes Set to Change How Pregnancy Care is Charged Starting January

Starting in January, maternity care billing in the United States will transition from a bundled payment model to an à la carte fee-for-service system using new Current Procedural Terminology codes developed by the American Medical Association. The American College of Obstetricians & Gynecologists supports this change, arguing that current bundled codes arbitrarily set prenatal visits at 13 and fail to account for the complexity of modern maternity care, including patients with complex medical needs and care provided by multiple practitioners like midwives and maternal-fetal medicine specialists. However, patient advocates and some employers express concern that the new system could result in higher out-of-pocket costs for patients, especially those with high-deductible health plans, as more itemized charges appear on bills. Insurance companies have raised concerns about the implementation timeline and operational changes required. The final impact on patient costs will depend on how insurance payers choose to implement and reimburse under the new codes, and the Centers for Medicare & Medicaid Services must still approve the proposed fee schedule.