The Way We Bill for Pregnancy Care Is Changing

Pregnancy in the US will soon come with a more itemized—and possibly higher—price tag. Starting in January, a billing code overhaul will end the current "one code covers it all" model for prenatal, delivery, and postpartum care—essentially, the use of global codes that cover nine months of care. As of 2027, OB-GYNs will use codes that "allow care to be reported more granularly at the service level," as the American Medical Association puts it, changing a system that, aside from some adjustments in 2009, has been in place for roughly 30 years, reports Healthcare Dive.

Supporters, including the American College of Obstetricians & Gynecologists, argue the change better reflects reality: Higher-risk patients can require more appointments, multiple specialists, and longer or more complicated deliveries than a flat bundle assumes. As the AMA explains, the current approach "simplifies billing, but obscures care variation and complexity."

What it means for wallets is murkier. Experts warn that patients with high-deductible plans could see more line items—and more out-of-pocket costs—if insurers pass along the added detail. Employers and insurers worry the shift back toward fee-for-service will incentivize extra tests and higher-cost providers, potentially driving up premiums. Medicaid patients, who account for about 41% of US births, likely won't see a financial impact. Advocates say the granular data could help improve maternal health by allowing researchers to better track "whether specific services move the needle on maternal mortality rates," as KFF Health News puts it.