AMA Introduces New Maternity Care Coding for Better Patient Outcomes
The American Medical Association (AMA) has announced the introduction of new obstetric codes set to replace the current bundled global obstetric payment system for maternity care services starting January 1, 2027. This change aims to better reflect the evolving practices of obstetricians and gynecologists (ob-gyns) in the United States. The development follows the American College of Obstetricians and Gynecologists (ACOG) advocacy efforts, backed by its Committee on Health Economics and Coding, which successfully proposed the discontinuation of the global payment system.
ACOG's President, Dr. Steven J. Fleischman, emphasizes that these new codes align with clinical guidelines, aiming to reduce administrative burdens while enhancing data collection capabilities. This shift is expected to facilitate more patient-specific care, ensuring ob-gyns receive equitable compensation while adhering to clinical and regulatory compliance requirements.
The move away from global obstetric payments coincides with ACOG's April 2025 guidance on prenatal care delivery. This guidance prioritizes personalized care plans over traditional models, taking into account medical, structural, and social factors alongside patient preferences. Such personalization aims to reduce routine visits for low-risk pregnancies and integrate diverse care modalities like home monitoring, rendering the previous global payment model obsolete.
ACOG's CEO, Dr. Sandra E. Brooks, highlights that current payment systems fall short in accommodating the expanded scope of care. With an increased focus on home monitoring, telehealth, and comprehensive postpartum monitoring, the new codes are designed to better capture these varied pregnancy experiences, promoting enhanced patient-centered care and improved health outcomes.
Despite these changes, most patients will not experience increased costs, as many health plans adhering to the Affordable Care Act do not require cost-sharing for preventive services like prenatal visits. However, costs will continue to apply for labor and delivery services not classified under preventive care.
Although the full implementation of the new codes is scheduled for 2027, ACOG, in collaboration with the AMA, is developing resources to assist ob-gyns during this transition. These educational materials aim to ensure a smooth adaptation to the new system, reinforcing healthcare professionals' understanding of the updated coding structure in maternity care.