Opinion: Good riddance to bundled ‘global’ maternal care billing
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- OB-GYN billing codes will shift from a bundled "global obstetric payment" to a fee-for-service model on January 1, 2027, affecting nearly every U.S. family with a pregnancy.
- The current bundled system combines prenatal, labor and delivery, and postpartum care into a single bill, obscuring which services qualify as preventive care exempt from cost-sharing under federal law that covers roughly 93% of U.S. health insurance plans.
- The new coding structure will eliminate copayments for prenatal visits, screenings, and qualifying postpartum visits, while ultrasounds, lab tests, and labor and delivery remain subject to cost sharing — with complicated births potentially costing more and uncomplicated births costing less.
- Rural hospitals lose revenue under the bundled model when patients with serious complications are transferred, since only one payment goes to the delivery clinician; transfers from rural facilities occur in more than 25% of births, and fewer than half of rural hospitals still operate labor and delivery units.
- The fee-for-service model aligns with ACOG's recommendation for "tailored prenatal care," enabling individualized visit schedules, telehealth, team-based care, mental health screenings, and referrals addressing social determinants of health.
- New billing codes will generate granular clinical data — including labor length, visit counts, and complication management — giving researchers the ability to study what actually drives U.S. maternal morbidity and mortality outcomes.
Why it matters: Pregnant patients gain guaranteed copay-free preventive visits and clearer bills, while rural hospitals — which lose funds today every time a high-risk patient is transferred — finally get paid for the care they actually deliver. Researchers also gain the granular data that the bundled system withheld for decades, potentially reshaping how U.S. maternal health is studied and improved.
