Why maternity care needed new CPT codes

Why the American College of Obstetricians and Gynecologists advocated for change

The American College of Obstetricians and Gynecologists (ACOG) spent years advocating for a new maternity coding framework because modern maternity care no longer fits the decades-old payment model it was built on. Today's patients may receive prenatal care from multiple clinicians, deliver with a hospitalist they've never met before, and require postpartum care that extends well beyond a single follow-up visit.  

Rather than assuming every pregnancy follows the same schedule, practices are increasingly tailoring prenatal care to each patient's medical history, pregnancy risk factors, and individual needs.

As Dr. Lisa Hofler, advisor to the ACOG Committee on Health Economics and Coding, one of ACOG's advisors to the American Medical Association (AMA) CPT® Editorial Panel,¹ and a member of the workgroup that developed the new maternity codes, explained in an interview with athenahealth, "The old structure of how maternity care was kind of coded and reported doesn't work for today's modern obstetric practice."

That evolution is what drove years of advocacy from ACOG, culminating in the AMA's new obstetric CPT code set, effective January 1, 2027.²

More than a coding update, these changes are designed to better align payment and documentation with modern maternity care. They create an opportunity to better support care that reflects each patient's unique needs, improve transparency for practices and patients, and generate the data needed to better understand what drives healthier maternal outcomes.  

Through this collaboration, athenahealth and ACOG are helping OB-GYN practices understand not just what is changing, but why it matters — and how thoughtful workflows, technology, and services can help them prepare with confidence.  

This article is the first in a three-part series exploring the future of maternity care. We'll begin with the bigger picture: why the traditional global OB package no longer reflects modern obstetric practice, why ACOG advocated for change, and what these updates mean for independent and community-based practices.

Maternity care has evolved. The coding model hadn't.

For decades, the traditional global OB payment model reflected how maternity care was delivered: one physician or one practice provided prenatal care, managed labor and delivery, and followed the patient through postpartum care.

Today, however, patients may move, change insurance plans, or transfer care during pregnancy. Many deliver with an OB hospitalist rather than the physician who managed their prenatal care. Others require referrals to maternal-fetal medicine specialists or additional support for chronic conditions such as hypertension or diabetes.  

As Dr. Hofler explained in an interview with athenahealth, the original maternity coding structure was built around a model in which one physician cared for a patient throughout pregnancy, delivery, and postpartum. Today, she said, "that kind of one package that lasts basically a whole year frequently doesn't work for whatever's going on with the person."

The shift doesn't end with delivery. The postpartum period — the “fourth trimester” — is increasingly recognized as a critical period that often requires more than a single follow-up visit. Yet the traditional global OB package was designed around a simpler model of care, one that no longer reflects how today's OB-GYN practices care for patients.  

That growing disconnect is what led ACOG to advocate for a new maternity coding framework — one designed to better support today's care model while laying the foundation for better data, greater transparency, and more individualized care.

Why the American College of Obstetricians and Gynecologists advocated for change

A simple idea has driven the history of ACOG advocacy: if maternity care has evolved, the systems used to measure, document, and support that care need to evolve as well.

Better care deserves better data

For years, the traditional global OB package made it difficult to understand what maternity care looked like across the country. Because prenatal care, labor and delivery, and postpartum care were largely reported as a single bundled service, it offered little visibility into the care patients received along the way. Without that visibility, it's difficult to answer important questions: How many prenatal visits are patients receiving? How often do pregnancies require more intensive management? What types of postpartum care lead to better outcomes? Which interventions have the greatest impact on maternal health?

As Dr. Hofler explained, the global payment model made it difficult to study those questions at scale. While individual organizations could evaluate their own patient populations, the broader healthcare community lacked consistent data to understand what types of care improve outcomes across diverse practice settings. 

A more detailed coding framework creates new opportunities to better understand maternity care as it's delivered today — supporting research, informing quality improvement efforts, and helping clinicians and policymakers identify practices that lead to healthier pregnancies and postpartum outcomes.

More transparency for patients and practices

The new framework also brings greater transparency to maternity care. Under the traditional bundled payment model, it wasn't always clear to patients which services were considered preventive, which were associated with labor and delivery, or how different aspects of their care were reflected in billing. According to Dr. Hofler, greater transparency can help patients better understand the care they're receiving while strengthening trust between patients, clinicians, and the healthcare system.  

Ultimately, ACOG’s goal was to create a payment and documentation framework that better reflects how OB-GYN practices deliver care today — supporting individualized care, improving transparency, and generating the insights needed to advance maternal health in the years ahead.

What this means for independent OB-GYN practices

For many independent and community-based OB-GYN practices, the 2027 maternity coding transition may feel like one more change to navigate. But viewed through a broader lens, it's an opportunity to align documentation, workflows, and reimbursement with the realities of modern maternity care. And because the new obstetric CPT codes don't take effect until January 1, 2027, practices have time to prepare thoughtfully rather than react at the last minute.

As Dr. Hofler noted during her conversation with athenahealth, the greatest implementation challenge may not be reimbursement mechanics. Instead, it will be ensuring that documentation workflows support compliant evaluation and management (E/M) billing without creating significant additional burden for clinicians. Rather than documenting pregnancy differently, practices will be documenting pregnancy more consistently with how they already document other evaluation and management services.

For independent practices, that makes workflow just as important as coding. The goal is to build processes that better support the care patients need while helping clinicians and staff capture the work they're already doing. That's where thoughtful planning, education, and technology can make the transition significantly easier.

A shared commitment to helping practices prepare

Practices shouldn't have to navigate the 2027 maternity coding transition alone. That's why athenahealth and ACOG are partnering to help practices prepare for this transition together. ACOG brings the clinical, coding, and policy expertise behind the new maternity framework, while athenahealth is working to ensure athenaOne® for Women's Health supports those changes in ways that reflect the realities of modern OB-GYN practice.

Together, the goal is to help practices move beyond compliance and toward confident implementation. That means supporting documentation workflows that fit naturally into clinical care, reducing operational complexity where possible, and helping practices adapt without losing focus on delivering individualized, high-quality maternity care.

Preparing for the future of maternity care

The 2027 maternity coding transition is about aligning payment, documentation, and workflows with how maternity care is delivered today, while creating a stronger foundation for the future of women's healthcare.

For independent and community-based OB-GYN practices, that means looking beyond compliance and viewing this transition as an opportunity to better support individualized care, improve operational efficiency, and generate the insights that can help advance maternal health.  

Dr. Hofler describes implementation science as "making the right thing to do the easy thing to do." That's exactly what this transition should accomplish for practices.

Explore ACOG's educational resources and transition guidance to learn more about the new maternity coding framework.

In the next article in this series, we'll move from the "why" to the "how," exploring how practices can prepare documentation workflows, operational processes, and care teams for a smooth transition to the new maternity coding framework.