The American Medical Association will update its maternity care coding so insurers can be billed for individual phases of pregnancy, rather than a lump sum. Taking effect in 2027, the AMA will work with physicians, the Centers for Medicare & Medicaid Services, payers, and electronic health record vendors to standardize the new process.
The previous, decades-old Current Procedural Terminology (CPT) system bundled maternity into a single payment covering ~10 months of care. The new framework identifies four key phases: antepartum care, labor management, delivery, and postpartum care. The updated codes will gather information throughout a patient’s journey to provide more personalized support and advance maternal healthcare. An analysis of data from the CDC, payers, and over 650 obstetricians, family medicine physicians, and nurse midwives suggests that the new framework will not increase costs.
“Better information leads to better care,” said AMA President Willie Underwood III, MD, MSc, MPH. “Modernizing how maternity care is reported gives physicians a clearer picture of every stage of pregnancy and postpartum care, helping physicians improve outcomes for mothers and babies and laying a stronger foundation for maternal health research and quality improvement.”
Maternal healthcare faces an accessibility crisis in the US – health insurance coverage has dwindled for postpartum women, maternal mortality rates have increased, and the majority of voters support updated maternal healthcare policies. The AMA’s updates aim to address these gaps by enabling more individualized and continuous care, particularly as providers move toward more tailored prenatal and postpartum care.
“Physicians cannot improve what they cannot measure,” said Underwood. “These CPT revisions give physicians, researchers, and policymakers a clearer understanding of the care mothers receive throughout pregnancy and after delivery, helping identify opportunities to improve quality, strengthen accountability, and improve outcomes for mothers and babies.”
