New billing codes for maternity care will take effect in January, shifting from bundled payments to a fee-for-service system for pregnancy, childbirth, and postpartum care. The change, developed jointly by the American College of Obstetricians & Gynecologists (ACOG) and the American Medical Association (AMA), replaces a decades-old model that uses a single global code for all maternity-related physician services.

Under the current system, a fixed number of 13 prenatal visits is assumed, and one global code covers labor and delivery regardless of complexity or duration. “If someone comes in for a birth, no matter how long or how short their labor or how complicated or uncomplicated their delivery, the global reporting is the same because we only have one code,” said Lisa Hofler, chair of the Department of Obstetrics and Gynecology at the University of New Mexico and a member of the ACOG committee that helped develop the new codes. She added that 13 visits “is not really what most people need.”

The new system will allow for personalized prenatal and postpartum care, with billing based on actual services rendered—in person or remotely—and will enable hospitalists, midwives, and maternal-fetal medicine specialists to bill separately for their contributions. Extended postpartum care beyond the current standard of two visits will also be billable under the new codes.

“There will be more line items. Will that be passed along to patients, particularly those that are in commercial plans, in high-deductible plans?” said Laurie Zephyrin, an OB-GYN and senior vice president for the Achieving Equitable Outcomes initiative at The Commonwealth Fund. She emphasized that “the cost piece is really critical,” noting that out-of-pocket expenses for childbirth already average $2,743 for families with employer-sponsored insurance.

“Rushed implementation of far-reaching AMA code restructuring will fundamentally change how maternity services are managed and reimbursed,” said Chris Bond, a spokesperson for AHIP, which represents health insurance providers. Whether patients face higher costs will depend on how insurers adopt the new codes. The Centers for Medicare & Medicaid Services (CMS) is reviewing the changes, with a proposed fee schedule expected in July.

ACOG hopes the new system will improve care quality and support research into maternal health outcomes. The U.S. has the highest maternal mortality rate among high-income countries, and the current bundled system obscures which specific services were delivered, complicating efforts to analyze care patterns. Medicaid covers 41% of U.S. births, and beneficiaries are unlikely to see financial impacts, as the program typically imposes no out-of-pocket costs for maternity care.