Cotiviti says 2027 maternity coding changes require major health plan preparations
XLV•Maternity coding changes taking effect January 1, 2027, will require health plans to update payment policies, provider contracts and claims systems. CMS is considering 15 Medicare-specific codes to preserve global maternity payments, but implementation remains uncertain.
1. Preparation for coding changes
The American Medical Association’s maternity coding changes will shift reporting away from bundled services to encounter-based reporting across maternity episodes starting January 1, 2027. Health plans need to update payment policies, provider contracts and claims-editing systems; providers are encouraged to report prenatal care through evaluation and management services during 2026 for pregnancies continuing into 2027.
2. Medicare proposal remains uncertain
CMS is considering 15 Medicare-specific codes to preserve global maternity payments, while the American College of Obstetricians and Gynecologists opposes the proposal. More detailed claims data could improve quality measurement, risk adjustment and analysis of maternal outcomes.
