The end of the global obstetrics bundle: What you should know about the maternity billing reset claim

Jaclyn Chapman, Senior Manager, Deloitte Consulting LLP; Katherine Gordon Backes, Senior Manager, Deloitte Consulting LLP; Sarah Garcia, Senior Consultant, Deloitte Consulting LLP

The first installment in our Health Forward blog series on maternity billing explores the changes taking effect January 1, 2027, and considerations for health systems, health plans, clinicians, and patients as they prepare for the transition

Nearly 3.6 million babies were born in the United States last year. ⁱ Behind many of those births stands the same arc of care: roughly 13 prenatal visits for an uncomplicated pregnancy, labor and delivery, and postpartum follow-up, totaling 16 or more clinical encounters spread across the better part of a year. ⁱⁱ

For more than three decades, American health care compressed that arc into a single line item. The global obstetrics (OB) bundle—one code, one claim, one payment—treated nine months of care into one bundled payment. ⁱⁱⁱ High-risk monitoring, gestational diabetes management, laborist handoffs, telehealth check-ins, the work of the full care team: all aspects of prenatal care was combined into one charge.

On January 1, 2027, that reporting structure changes: the single line item becomes unbundled. The American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) are replacing the current global obstetrical package with a new itemized coding framework for reporting prenatal, labor management, delivery, and postpartum services. ^iv Pregnancy care will be billed the way it is delivered: visit by visit, clinician by clinician, and claim by claim.

Commercial insurance covers 52% of U.S. births, while Medicaid finances roughly 40%, with the remainder of individuals covered through other payment sources, self-pay or uninsured arrangements. ^v As a result, the transition has implications across virtually every segment of the maternity care ecosystem.

For revenue cycle leaders, this is likely to be the operational event of 2027.

There are potential opportunities to innovate care for better outcomes. Richer visit-level data, earlier identification of complications, and payment that rewards coordinated team-based care are levers for improving safety and quality for mothers and babies, the same data that helps a system negotiate is the data that can help a clinician catch a complication sooner.

A window that matters: September 2026

While the coding changes take effect on January 1, 2027, many organizations are likely already evaluating the operational activities involved in preparing. Payer contracts that reference global obstetric (OB) codes should be reviewed and, in many cases, amended before the new coding structure takes effect. ACOG recommends starting the transition to antepartum evaluation and management (E/M) coding in September and has been specific about what should be included: no visit limits and no prior authorization requirements for antepartum visits. ^vi Contract negotiations often take six to eight weeks or longer, making the month of September an important planning period for many organizations.

That cross-year cohort can be a risk. Patients who begin prenatal care this fall may ultimately deliver under the new code set. A patient who begins prenatal care in October 2026 and delivers in March 2027, for example, will span both coding structures, requiring organizations to address how those episodes will be attributed and submitted. Contracts left unamended past September may create reimbursement and claims processing challenges before go-live, while the organization is still, on paper, ahead of the deadline.

Beyond the bundle: greater visibility into maternal health needs

Moving from a bundled maternity payment to a more granular, encounter-level reimbursement and claims structure could provide greater visibility into the clinical, behavioral, and social needs that arise across pregnancy, delivery, and postpartum care. Rather than treating maternity care as a single episode, this approach may enable health systems, providers, and payers to better distinguish services associated with high-risk pregnancy management, gestational diabetes, pre-eclampsia monitoring, behavioral health, and social support. This additional transparency could support earlier identification of risk factors, more targeted interventions, improved care coordination, and a clearer understanding of the resources involved in serving patients with complex maternal health needs. However, greater granularity would not, by itself, ensure improved outcomes or adequate reimbursement; results would likely depend on coding quality, data completeness, payment design, and operational execution.

A more detailed reimbursement structure could also make the contributions of the broader maternal health care team more visible. Laborists, clinicians, midwives, community health workers, lactation consultants, mental health clinicians, and other professionals may be represented more clearly across the care journey. This could improve visibility into how care is delivered, which providers are contributing to patient outcomes, and where capacity or coordination gaps may exist and an opportunity to improve care as a result. The practical value would likely depend on consistent documentation, provider participation, appropriate attribution, and the ability to integrate data across settings.

The shift could create opportunities to evaluate and potentially expand care models that support patients throughout pregnancy and postpartum. Telehealth visits, remote patient monitoring, group prenatal care, and multidisciplinary support services may become more sustainable within reimbursement models, allowing women to access care in ways that are more convenient, continuous, and responsive to their individual needs.

Replacing a single bundled payment with encounter-level claims data may provide health systems and health plans with deeper insights into utilization, outcomes, and care gaps, helping identify opportunities to improve maternal health outcomes, care coordination, and future maternity contract negotiations.

Payers have a parallel opportunity. Consumers' needs are about to change shape, with multiple bills, new cost-share patterns, and new access points like telehealth and team-based care, and plans should consider anticipating those needs. By evaluating health plan readiness, strengthening care coordination, and identifying high-risk pregnancies earlier, payers could be better positioned to control costs while sustaining high-quality care. ^vii

This could be an opportunity to improve transparency and coordination without creating unnecessary administrative burden, affordability concerns, fragmented care, or confusion for pregnant and postpartum patients.

Potential unintended consequences

Denials are likely the single largest preventable financial and health outcome impact of this transition, and the mechanics can be stated plainly.

When major CPT coding transitions occur, claims submitted using retired or invalid codes may be denied if payer contracts have not been updated accordingly. ^viii Because adjudication systems validate claims against current coding requirements, outdated codes are often flagged as invalid, resulting in denials, reimbursement delays, and additional administrative burden.

Organizations may experience claim denials and reimbursement delays as they adapt contracts, systems, and workflows to support new coding requirements. ^ix

Two characteristics of the transition can make this exposure particularly challenging:

1. First, it is time-boxed: denied claims that age past timely-filing limits generally cannot be appealed. ^x A slow response could convert a recoverable problem into a permanent write-off.
2. Second, the impact tends to compound over time. Undercoding (when clinicians default to a lower-level E/M code than the visit supports) can create significant cumulative revenue leakage across high-volume prenatal care practices. Past E/M coding transitions have shown that insufficient provider training can contribute to undercoding, reducing reimbursement and creating avoidable revenue leakage as clinicians adapt to new coding requirements. ^xi Spread across thousands of prenatal visits per month, that could add up to significant annual revenue leak that no denial report will likely surface, because nothing was denied.

When radiation oncology moved away from bundled payment structures, the transition brought its own set of challenges, including documentation burden, billing complexity, and access issues that outlasted the policy change itself. ^xii

The closest recent analogue in scale, the 2021 E/M overhaul, produced a similar pattern of undercoding as clinicians continued to rely on familiar coding practices rather than fully adopting the new coding framework. ^xiii

Across these precedents, a consistent pattern emerges: organizations experience challenges at the end state. The greatest challenges tend to occur during the transition itself, in the months when contracts, systems, documentation habits, and payer logic are all mid-migration, and gaps between them is a claim that doesn't get paid, rather than after the new model is fully implemented.

Other factors and considerations

A transition that is not adequately planned and coordinated can create four distinct risks, each landing on a different constituency.

• Spending gets harder to forecast. A dozen-plus variable claims per pregnancy is a noisier signal than one bundled payment, both for systems modeling revenue and for payers pricing 2027 premiums and setting reserves.
• Administrative complexity rises. New coding structures and adjudication workflows increase operational complexity on both sides of the claims process.
• The care experience risks fragmenting. A woman who once received a single charge now navigates a stream of statements, cost-share calculations, and potential coverage changes mid-pregnancy.
• High-risk populations could feel it most. These patients often have the most visits, the most complex documentation, and the greatest exposure to eligibility changes.

Then there is the potential consequence that extends beyond the ledger. Coverage churn and billing friction can create additional obstacles to prenatal care, with the potential for missed visits, interrupted monitoring, and gaps in continuity of care. ^xiv

Roughly one in ten U.S. births is preterm. ^xv While many factors contribute to maternal and neonatal outcomes, consistent access to prenatal care remains important throughout pregnancy. ^xvi A transition that disrupts prenatal continuity can carry stakes measured in outcomes for families and, for health systems and payers, in the broader costs associated with complex maternal and neonatal care.

90-day revenue cycle considerations