On January 1, 2027, the CPT code set stops describing a pregnancy as one service. The American Medical Association's CPT Editorial Panel has deleted the global maternity codes and replaced them with reporting by phase: prenatal visits billed as evaluation and management (E/M) encounters, new labor management codes reported once per calendar day, streamlined delivery codes, and postpartum visits billed as E/M encounters. The AMA's implementation summary lists seventeen deleted codes, twelve new codes and six revised codes; CMS's proposed valuation discussion describes nine revised codes, reflecting a different way of grouping the affected code family. The operational point is the same: maternity work will no longer be recorded through the familiar global bundles. The AMA says the redesign reflects team-based care, tailored prenatal schedules and labor management that has become more complex than the old codes described.[1][2]
Most of the commentary so far has been about billing. The larger effect for employed obstetricians may be on compensation plans that use work relative value units (wRVUs), because the wRVU record of a pregnancy is about to change shape.
The global code put the whole pregnancy on one line
Under the current structure, a routine pregnancy with a vaginal delivery may be reported through a single global code covering prenatal visits, delivery and postpartum care. A group using that structure then decides how its compensation plan attributes the associated wRVUs among the physician who delivered, partners who covered prenatal visits, and midwives or other advanced practice providers who participated in the care.
From 2027, CPT reporting follows the encounter or phase of care. The clinician who performs a prenatal visit reports it. The clinician who manages labor reports the labor management day. The clinician who delivers reports the delivery. Subject to payer rules and the employer's attribution policy, a physician who delivered the patient but saw her for three of twelve prenatal visits would have the delivery and three visits recorded under that clinician, while the midwife who saw her for the other nine would have those visits recorded separately. The care team may be identical. The production record is not.
Plans calibrated to the old record may need to change. Tier thresholds, wRVU targets and conversion factors may have been set against global-code production. Consider a hypothetical group in which a physician delivered 150 patients last year and was credited the full global for each, while the group's midwives handled most of the prenatal care. If the group keeps its old attribution policy in 2027, the physician's credited work for the same 150 patients could become 150 deliveries plus the visits she personally performed, potentially moving her below a tier threshold set in 2024. The midwives' credited work could rise by the visits they performed and exceed a target that was never designed for encounter-level maternity coding. The group's total credited work may also differ from the old total, because the new components are not guaranteed to add up to the former global value.
The values are not final
The AMA/Specialty Society RVS Update Committee (RUC) surveyed more than 650 obstetricians, family physicians and nurse midwives and sent recommendations to the Centers for Medicare & Medicaid Services (CMS) in February 2026 that it describes as budget neutral.[1] In the proposed rule for the 2027 Medicare Physician Fee Schedule, CMS did not simply adopt them. It proposed to revise the utilization assumptions behind the code family, removing four of the twelve prenatal visits the RUC had assumed, and to reallocate that work value toward the new labor management and delivery codes. It also asked for comment on whether to create Medicare G-codes that would preserve the current global coding and payment for Medicare patients in place of the new CPT codes.[2][3] As of late October 2026 the final rule has not been published; the AMA expects it in early November.[1]
Medicare covers a small share of births, but the Medicare values still matter where an employer's compensation plan applies CMS wRVUs across the physician's entire payer mix. In those plans, the values CMS finalizes may become the production credit used internally even for Medicaid patients, who accounted for 40.2 percent of U.S. births in 2024, and for commercially insured patients.[4] That is a compensation-plan convention, not a statement that every payer will adopt Medicare's payment policy. If CMS finalizes G-codes for Medicare while Medicaid and commercial payers use the new CPT structure, plans will need to define which code-and-value structure controls internal credit and how payer-specific differences are handled.
2027 will be a transition year in the data
The AMA's transition guidance adds a timing problem. Prenatal visits performed in 2026 for a patient who delivers in 2027 are reported under 2026 rules, using the antepartum-only codes (59425 or 59426) when there were four or more visits, while the 2027 delivery is reported with a new delivery code.[5] For pregnancies spanning the transition, prenatal services performed in 2026 are reported under 2026 rules, while prenatal encounters and delivery services performed in 2027 are reported under the new structure. Comparing a physician's 2027 wRVUs to 2026 wRVUs, or to a benchmark built from 2026 survey data, compares two different accounting conventions.
Labor management is a second shift. The global code never described it separately; from 2027 it has its own codes, reported per calendar day and split between straightforward and complex care.[1] For hospitals that support obstetric hospitalist or laborist programs through stipends, the professional revenue those programs generate is about to change, and the analysis behind the coverage payment should change with it.
What this means for fair market value
A fair market value opinion on an OB/GYN compensation arrangement for 2027 rests on two wRVU measures: how many wRVUs the physician is expected to produce, and the rate paid per wRVU. Both are usually tested against survey benchmarks that will, for at least another year, reflect production under the global codes. An opinion that compares 2027 production to those benchmarks without saying which code structure each side reflects is comparing two different things.
The practical work is to rebase before the plan runs on 2027 data. Take 2026 encounters, recode them under the 2027 structure using the proposed values and then the final rule, and see where each clinician and the group as a whole land. Decide deliberately how team-based prenatal care will be credited rather than letting the new codes decide it. Reset tiers and thresholds that were calibrated to global-code production. Write down the method, including how the 2026 to 2027 transition is handled, so the compensation file explains why 2027 wRVUs look different from 2026 and from the survey, and so the fair market value opinion can say which code structure its benchmarks and its projections each reflect.
Sources & Notes
- American Medical Association, "CPT 2027 Maternity Care Services code changes," updated September 17, 2026, https://www.ama-assn.org/practice-management/cpt/cpt-2027-maternity-care-services-code-changes.← 1← 2← 3← 4
- Centers for Medicare & Medicaid Services, "Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies," proposed rule, 91 Fed. Reg. 43842 (July 16, 2026), CMS-1848-P, section II.D.5.c.(27), "Maternity Care Services," including "Comment Solicitation on Maintaining Current Coding Through Creation of HCPCS G-codes," https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-other.← 1← 2
- Public comment letters on CMS-1848-P describing the proposal: Ob Hospitalist Group, July 16, 2026, https://downloads.regulations.gov/CMS-2026-2377-0093/attachment_1.pdf; AHIP, September 14, 2026, https://downloads.regulations.gov/CMS-2026-2377-42178/attachment_1.pdf; and American Academy of Family Physicians, summary of the CY 2027 proposed rule, July 17, 2026, https://www.aafp.org/assets/image/upload/v1784322005/pdf_mpfs_summary_071726.pdf.← 1
- Martin JA, Hamilton BE, Osterman MJK, "Births in the United States, 2024," NCHS Data Brief No. 535, National Center for Health Statistics, July 24, 2025, https://cdc.gov/nchs/products/databriefs/db535.htm.← 1
- American Medical Association, "FAQs: CPT 2027 coding for maternity care spanning the transition date," September 17, 2026, https://www.ama-assn.org/practice-management/cpt/faqs-cpt-2027-coding-maternity-care-spanning-transition-date.← 1