Opinion: New billing codes likely to raise maternity care costs
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- American Medical Association will eliminate global professional payment codes for deliveries by Dec. 31, replacing them with separate fee-for-service codes for prenatal visits, postpartum care, fetal monitoring, and procedures, on the recommendation of the American College of Obstetrics and Gynecology.
- Global maternity codes have been in place since the 1990s, and since 2000 U.S. cesarean delivery rates climbed from 22.9% to 32.5%, while maternal mortality and severe maternal morbidity remain the highest among wealthy nations.
- AMA says the change is cost-neutral, but actuaries did not include the new billing in 2026 budgets — employers will see unanticipated claims starting mid-2026 when providers begin billing prenatal visits under office-visit codes for deliveries in 2027.
- Prenatal visits will be billed at office-visit intensity levels 2 through 5, with level 5 paying roughly twice level 3, creating incentives — and likely AI-assisted documentation — for providers to bill at higher intensities.
- Procedures previously bundled into the global fee, including labor induction and fetal monitoring, will now be billed separately, raising the risk of more interventions and higher cesarean rates in low-risk pregnancies, while site-of-service billing could enable hospital facility fees for visits performed in hospital-employed physicians' offices.
- Average U.S. delivery costs ran $15,712 for vaginal births and $28,998 for cesareans in 2021–2023, with average out-of-pocket cost at $2,743; employers — and Medicaid, which each cover about half of all deliveries — will absorb most added costs, while professional fees represent only about one-fifth of total maternity spending.
- Author Jeff Levin-Scherz urges employers to query insurers on claims-system readiness and ensure actuaries incorporate the billing change's impact into 2027 premium rates, and to use newly granular claims data to assess prenatal and postpartum visit timing.
Why it matters: Employers and Medicaid programs — each paying for roughly half of U.S. deliveries — will absorb most added cost from unbundling maternity billing, with professional fees currently only about one-fifth of total maternity spending; the shift to fee-for-service could intensify billing, encourage more interventions in low-risk pregnancies, and produce unexpected claims in 2026 before premiums can be recalibrated for 2027.
