January 1, 2027: CPT 59400 and 59510 retire. Maternity care unbundles into four separately billed phases, and the contracted global rate retires with the code. Move four sliders. See your practice's exposure in real time.
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Same practice, same volume. What changes is what the note supports.
Built on AMA RUC recommended values submitted February 2026, scaled to the CMS 2026 conversion factor. Your real exposure depends on your contracts and your documentation. Refresh when CMS final rule publishes November 2026. This is not tax, legal, or compliance advice.
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The gap on the calculator is real. So are the three practical moves that close it before January 1, 2027.
This calculator was written by the people who work the change, not by people describing it from a distance.
Sourced from live webinar Q&A. Answered from AMA, ACOG, and CMS guidance.
The ACA requires prenatal care to be covered as first-dollar preventive care, meaning no copay or deductible for the patient. Under the old global code model, payers had to decide how to split the preventive portion from the non-preventive portion, which created inconsistency.
Under the new E/M code model, ACOG has formally recommended that health plans cover antepartum E/M visits without limitations, prior authorization, or cost-sharing. However, this is a recommendation, not a federal mandate tied to specific new codes.
What to do: contact your top commercial payers and ask how they will classify antepartum E/M visits with modifier TH for cost-sharing. Get it in writing before January 2027.
September 1 is ACOG's recommended transition date, but the codes you submit in September are NOT new 2027 codes. They are existing E/M codes (99213, 99214, 99215) that payers already process every day. The only thing new is modifier TH appended to identify the visit as maternity-related.
Payer systems already know how to handle E/M codes. The modifier TH is the piece that may not be configured yet. Some payers may not be ready in September. Their claims systems may deny the claim outright, attempt to rebundle it into the global code, or pay it incorrectly without modifier recognition.
What to do before September 1: pick top 3 payers by OB volume. Submit a small batch of test claims with 99214-TH and a Z34 ICD-10 before September. Watch what comes back.
Patient delivers BEFORE Dec 31, 2026: bill the global code (59400 or 59510) as you do today. The full episode completes in 2026 under the old rules. No change needed, bill as normal.
Patient delivers ON OR AFTER Jan 1, 2027: this is the transition case. If you have already billed a global code for this patient, you cannot retroactively unbundle it. Revenue for those 2026 visits may be at risk. ACOG guidance: begin billing individual E/M visits with modifier TH now for any patient expected to deliver in 2027.
Act now: switch to E/M billing immediately for any patient expected to deliver in 2027. Each visit gets its own claim under the 2027 codes.
Not yet. CMS proposes rates in July 2026. Final values publish in November 2026. Feb 2026 (done): AMA/RUC submitted work RVU recommendations to CMS based on surveys of 650+ OB providers. July 2026: CMS publishes proposed relative values in the Physician Fee Schedule.
Oct 2026: the 60-day public comment period ends. Practices and professional societies can submit comments. Nov 2026: CMS publishes the final rule with final RVU values. These become effective January 1, 2027.
For your revenue model: the RVU values in this calculator are AMA RUC recommendations, expected but not final. Check the November 2026 final rule and refresh the model. The AMA/RUC say the overall package is designed to be budget neutral.
Practices likely to see improvement: hospitalist/laborist models (labor management previously uncompensated). High-acuity, high-complexity patient panels (complex codes reward documentation). Team-based care where multiple providers share the episode. Practices with strong documentation and accurate E/M level selection.
Practices at revenue risk: low-risk, low-visit-count patient panels (fewer E/M events to bill). Practices that undercode by habit (99213 on every visit). Practices that don't track or bill every antepartum visit completed. Practices that haven't renegotiated payer contracts before Q4 2026.
Bottom line: budget neutral means total RVUs sum to the same. Individual practice outcome depends on documentation quality, visit completion, and payer contract rates. The transition is a redistribution, not a universal cut.
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