CMS has announced the deletion of 16 global obstetric billing codes effective January 1, 2027. These codes — which currently bundle prenatal care, delivery, and postpartum care into a single global fee — will be replaced with unbundled E/M billing using a new TH modifier. For OB/GYN practices, this is the largest billing code change in obstetrics in decades.
The practices that prepare now have a 9-month window to rebuild their obstetric billing workflows, train their billing staff, and negotiate updated fee schedules with payers before the change takes effect. The ones that don’t prepare will face a billing disruption in January 2027 that affects every obstetric patient in their panel simultaneously.
What’s Changing: The 16 Global OB Codes Being Deleted
The current global OB billing model bundles:
- All antepartum visits (up to 13 included in global fee)
- Delivery (vaginal or cesarean)
- Postpartum care (6-week check)
Under the current model, most obstetric care is billed as a single global package — one claim for the entire episode of care. This simplifies billing but obscures the actual service volume.
Under the new model starting January 1, 2027, each component is billed separately:
- Antepartum visits: E/M codes (99202–99215) per visit with the new TH modifier
- Delivery: Existing delivery codes (59400, 59409, 59410 for vaginal; 59510, 59514, 59515 for cesarean) — these are not being deleted
- Postpartum: Separate E/M visit with TH modifier
What OB/GYN Practices Need to Do Before January 2027
Step 1: Audit your current payer contracts. Global OB fee schedules are negotiated separately from E/M fee schedules. When the global code disappears, the payer needs a fee schedule for the replacement E/M codes billed with TH. Some payers will proactively update — many won’t. Your billing team needs to identify every payer that has a global OB fee in your contract and initiate renegotiation.
Step 2: Update your billing templates. Every OB billing template currently configured around global codes needs to be rebuilt for E/M + TH modifier billing. This includes charge entry workflows, claim templates in your billing system, and the fee schedule by CPT code for every contracted payer.
Step 3: Train documentation staff. Unbundled billing requires documented E/M services for each antepartum visit — history, exam, and medical decision making or time documented per visit. The global model’s documentation requirements were less granular. E/M-based billing requires the documentation to support the level billed.
Step 4: Train your billing team on TH modifier rules. The TH modifier (Mental Health/Behavioral Health Treatment) is being repurposed for this OB use. Modifier application rules and payer-specific requirements need to be documented before January 2027.
Current OB/GYN Billing Problems (Before 2027)
Beyond the 2027 change, current OB/GYN billing has three recurring problem areas:
Antepartum visit count tracking. The global package includes a specific number of antepartum visits. Visits beyond the included count are separately billable (CPT 59425 for 4–6 additional visits, 59426 for 7+ additional visits). Most practices either miss billing these entirely or bill them without verifying the visit count against the global package threshold.
High-risk obstetric services. Patients with high-risk conditions (preterm labor, gestational diabetes, preeclampsia) require additional visits and monitoring that may be separately billable beyond the global package. Documenting and billing these correctly requires a biller who knows when the additional services qualify for separate billing under payer-specific high-risk pregnancy rules.
Gynecology vs. obstetrics payer routing. Some payers route OB claims through a different payment model than gynecology claims. Applying the wrong routing to a gynecology procedure generates a payer-specific processing error that doesn’t always generate a clean denial — it may simply process at the wrong rate.
Frequently Asked Questions
What is the 2027 OB/GYN global billing change?
CMS is deleting 16 global obstetric billing codes effective January 1, 2027. These codes currently bundle prenatal care, delivery, and postpartum into a single fee. The replacement model uses individual E/M codes per antepartum visit with a new TH modifier, plus existing delivery codes billed separately. OB/GYN practices need to rebuild billing workflows, renegotiate payer fee schedules, and update documentation standards before the change takes effect.
What CPT codes will replace global OB billing?
Antepartum visits: standard E/M codes (99202-99215 for new/established patients) with the TH modifier per visit. Delivery codes (59400, 59409, 59410 for vaginal; 59510, 59514, 59515 for cesarean) remain unchanged. Postpartum visit: E/M code with TH modifier. The specific E/M level for each visit depends on MDM or time documented per the 2021 E/M guidelines.
How does current global OB billing work?
Currently, the global OB package (59400 for complete vaginal OB care, 59510 for complete cesarean) bundles all antepartum visits (up to 13), delivery, and postpartum care into a single negotiated fee. Additional antepartum visits beyond the included count bill separately as 59425 (4-6 visits) or 59426 (7+ visits). This model remains in place through December 31, 2026.
See our OB/GYN billing services — or start the free pilot now to prepare for the 2027 transition.
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