Obstetric clinicians around the country are questioning how the upcoming restructuring of maternity care CPT codes might impact how they deliver care and run their practices. On August 21, more than 160 of them attended an Ob Hospitalist Group (OBHG) webinar looking for answers.
And while the presenters – OBHG Chief Medical Officer Dr. Mark Simon, Vice President of Clinical Operations Dr. Shauna Depta, and Dr. Christina Adams, an OB hospitalist at UF Health Flagler Hospital in St. Augustine, Florida – provided plenty of solid answers, they were up front about one inescapable fact: There are still many effects we can’t yet predict.
Updating a ‘somewhat antiquated’ system
Today, maternity care is billed as one “global” service covering an entire pregnancy, from prenatal visits through delivery and postpartum care, typically paid to a single physician of record.
“That model has slowly changed,” said Dr. Simon. “The bundled payment system from decades ago is somewhat antiquated now.”
Today, pregnancy care increasingly involves more than one clinician, with a community physician handling office visits while a hospitalist covers the actual labor and delivery. Starting Jan. 1, 2027, the new CPT codes will reflect how care is actually being delivered, separating the global service into distinct pieces, each billed individually by whoever provided that specific service.
What might – or might not – change
Budget neutrality is the goal, said Dr. Simon: The total relative value units (RVUs) of the new codes is meant to approximate today’s global fee, aggregated across the system. But the panel candidly remained uncertain whether the system-wide budget neutrality would be enjoyed by individual clinicians.
“My hope is that in private practice, compensation should be either unchanged or slightly improved,” Dr. Simon said. “And I think that’s going to be true based on the numbers I see. But none of us are really going to know until it plays out.”
However, the panelists were more certain about one potential upside: In 2027, clinicians will no longer have to attend every delivery just to protect their reimbursement for the rest of their maternity care services.
“There’s more flexibility now,” said Dr. Depta. “[Clinicians are] rethinking how they spend their time. Is it worthwhile to go to the hospital and spend hours in a delivery while you’re canceling or rescheduling patients?”
The new unbundled codes will open the possibility for a hospitalist to perform the delivery and leave the private practitioner room to see more patients in the office, she said.
The known unknowns
RVU values are still being set, with a final rule from CMS expected in early November. CMS has also proposed a slate of new G-codes – usually intended to allow clinicians to make Medicare claims for services that CPT has no specific codes for yet – mirroring CPT’s present-day global maternity care codes.
The American College of Obstetricians and Gynecologists (ACOG) has urged Medicare to abandon the G-codes, predicting that having two different coding and billing structures would unleash “disruption and confusion by increasing administrative burden for obstetric clinicians and practices.”
Dr. Simon has voiced similar concerns publicly, arguing that the G-codes would preserve an outdated payment model that ignores the work of OB hospitalists and other clinicians. OBHG has also expressed support for the new CPT structure over a parallel one.
Outside of Medicare, private payer adoption is its own open variable, likely to vary by insurer, at least in the near term, the webinar panelists said. Whatever CMS decides, the value of “having separately identifiable codes for who provided what service” will remain an upside from a quality standpoint as much as a billing one.
The bottom line
This is a significant change to how obstetric care gets billed, not to how it gets delivered. The panel’s clearest message was that patient care, clinical collaboration, and the OBHG hospitalist model remain the constant.
“I want clinicians, physicians, midwives who are practicing obstetrics in this country to be able to do what they enjoy doing,” said Dr. Simon. “If they’re doing that, they’re going to provide better care to the patients.”
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