AMA Announces Restructuring of CPT Codes for Maternity Services

The American Medical Association (AMA) recently announced an overhaul of its current procedural terminology (CPT) codes for maternity health care services, effective January 1, 2027. The new structure is a significant departure from the “global” CPT code that currently covers most such services, which the AMA acknowledges simplifies billing but obscures care variation and complexity. Unbundling the various services that comprise the full pregnancy care spectrum will help address these issues. Moreover, it will establish the data foundation necessary to further improve maternal health. However, health insurance plans have raised several concerns, not the least of which is the impending effective date does not give them adequate time to revise their reimbursement payment structures and contracted rates with providers. In the 2027 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS proposed to both adopt the new CPT codes and create Healthcare Common Procedure Coding System (HCPCS) codes to preserve the existing payment structure, a move that the American College of Obstetricians and Gynecologists (ACOG) and other provider groups have expressed concerns about.