Quick answer: The global maternity package covers routine antepartum care, delivery, and postpartum care. Complications that require services beyond routine care may be billed separately when documentation supports them, sometimes with modifiers 25 or 57. Rules are changing on January 1, 2027, so confirm each payer's policy.

Global maternity billing has long simplified OB/GYN reimbursement. One code covers routine antepartum care, delivery, and postpartum services, which is clean and easy as long as the pregnancy follows a routine course.

Problems start when a pregnancy needs additional medical management, unrelated care, or treatment outside the global package. Those encounters can be separately reportable, but only when the documentation, coding, and payer rules support it.

There's also a bigger shift coming. CPT is restructuring maternity care reporting effective January 1, 2027, retiring the traditional global codes in favor of phase-specific reporting across four categories: antepartum care, labor management, delivery, and postpartum care. In total, 17 codes are being deleted, 12 added, and 6 revised, making this one of the most substantial coding overhauls OB/GYN billing has seen in decades. Practices operating through the second half of 2026 need to understand both systems at once.

What the Traditional Global Package Covers

Under the 2026 framework, global codes like 59400, 59510, 59610, and 59618 represent comprehensive maternity services when the requirements for that code are met. The package generally includes:

  • Routine antepartum care

  • Delivery

  • Routine postpartum care

It's often associated with roughly 13 antepartum visits, but that figure isn't a universal payer threshold. Prenatal care varies by patient and by payer policy, and CPT itself now favors a more individualized visit schedule over a fixed count.

The takeaway for billing teams: focus on why an additional visit happened and what work was done, not just the visit count. Routine follow-ups rarely qualify for separate reporting. Complications and medical problems deserve closer review.

When a Complication May Support Separate Billing

Common examples:

  • Gestational diabetes requiring active management

  • Preeclampsia or other hypertensive disorders

  • Hyperemesis requiring evaluation

  • Threatened preterm labor

  • Other conditions that materially change pregnancy management

A complication diagnosis alone doesn't settle the question. What matters is whether this specific encounter represents work reportable outside the global service under applicable rules.

Example: a patient with gestational diabetes returns for glucose review, medication adjustment, and treatment planning. If that visit involves significant work beyond routine prenatal care and the payer allows separate reporting, the chart should clearly document the distinction.

Modifier 25: Not Automatic

Modifier 25 identifies a significant, separately identifiable E/M service performed the same day as another procedure by the same clinician.

The correct sequence:

  • Confirm the encounter is separately reportable

  • Select the correct E/M code

  • Check whether another service occurred that day

  • Apply modifier 25 only when its requirements are met

Skipping steps leads to both underbilling and modifier misuse.

Unrelated Conditions During Pregnancy

Pregnant patients get sick with things that have nothing to do with the pregnancy: a UTI, bronchitis, a migraine, an orthopedic injury. These get evaluated under standard billing rules, with diagnosis and documentation reflecting the condition treated.

Modifier 24 covers something different: an unrelated E/M service during a surgical global period. It's not a catch-all for unrelated care during antepartum pregnancy.

The constant across all of this is accurate documentation of what was evaluated and what work was done.

Postpartum Complications

Close review is warranted for:

  • Postpartum hemorrhage requiring intervention

  • Evacuation of a postoperative hematoma

  • Wound repairs

  • Fistula-related procedures

The word "postpartum" isn't itself a billing category. Some postpartum encounters are separately billable, others are routine care. The service, timing, procedure, documentation, and payer requirements determine which.

Modifier 57

This applies to an E/M service that results in the initial decision to perform major surgery, for example an evaluation that leads directly to a cesarean. It's not a general same-day-surgery modifier. Documentation needs to show the encounter itself drove the surgical decision.

Documentation That Supports Separate Reporting

For a potentially separate complication encounter, the chart should let a reviewer understand:

  • The condition evaluated

  • Why the encounter was necessary

  • The additional work performed

  • How the condition affected management

  • How the service differed from routine prenatal care

  • The supporting diagnosis

  • Whether another service occurred that day

  • The rationale for any modifier used

A separate note is often worthwhile when a provider does substantial problem-focused work on top of routine prenatal care. The goal isn't billing every possible encounter. It's making sure services that legitimately qualify don't get missed.

The January 1, 2027 Change

CPT is retiring the traditional global maternity codes, including 59400, 59510, 59610, and 59618, and replacing them with phase-specific reporting:

  • Antepartum care, reported with standard E/M codes

  • Labor management, a new subsection with four codes (59080–59083) covering care from the onset of labor through delivery

  • Delivery, with new vaginal and cesarean delivery codes replacing the old, bundled versions

  • Postpartum care, also reported with standard E/M codes

The American College of Obstetricians and Gynecologists (ACOG) recommends appending modifier TH to prenatal and postpartum E/M visits to identify them as maternity-related, and some payers have already started requiring it ahead of the official 2027 effective date. This is a full restructuring of how maternity care gets reported across the episode, not a one-to-one code swap.

Navigating the 2026 Transition

Antepartum services provided in 2026 still follow 2026 rules:

  • 4-6 visits: CPT 59425

  • 7+ visits: CPT 59426

  • 3 or fewer visits: report encounters individually with E/M codes

Encounters in 2027 shift to the new framework.

Health plans may set their own transition timelines, and some have already moved early. Practices should confirm requirements payer by payer rather than assume uniform rules, and watch for payer notices requiring modifier TH on prenatal E/M claims before the 2027 deadline. A solid RCM workflow keeps a payer-specific transition matrix tracking effective dates, billing methods, modifiers, applicable codes for both years, claim requirements, and exceptions.

Why This Is a Workflow Change, Not Just a Coding Change

Traditional global billing is largely retrospective: practices review the pregnancy record before deciding what to report. The new system creates more frequent billing events and demands tighter attention to:

  • Charge capture

  • E/M documentation

  • Diagnosis selection

  • Modifier use (including TH, 25, 24, and 57)

  • Payer-specific requirements

  • Claim timing

  • Denial patterns

  • EHR configuration

  • Staff training

Waiting until January 2027 to build these workflows risks avoidable claim edits and rework.

A Practical Example

A patient receiving routine prenatal care develops gestational diabetes. Her routine visits continue, but she now also needs encounters focused specifically on glucose management, medication adjustment, and treatment planning.

Under the 2026 framework, the billing team reviews whether those additional encounters meet the requirements for separate reporting, rather than assuming they qualify by default. Where documentation supports it, the team identifies the right E/M service, diagnosis, and modifier for the specific encounter and payer.

Under the 2027 framework, this same antepartum management shifts into per-encounter E/M reporting, appended with modifier TH, instead of accumulating toward a global code.

How QWay Healthcare Approaches This

The gap in most OB/GYN billing isn't knowledge of individual CPT codes. It's a workflow that doesn't consistently flag which services need review. A strong process includes:

  • Reviewing antepartum records for separately reportable services

  • Identifying complication-related encounters

  • Checking documentation before submission

  • Applying modifiers only when supported

  • Monitoring payer policies, including early TH modifier mandates

  • Tracking 2026 and 2027 rules separately

  • Preparing EHR and billing systems for the new structure

  • Auditing claims and denials for patterns

QWay Healthcare treats this as a revenue-cycle workflow challenge, aiming to capture and report the care delivered under the rules that apply on the date of service.

Frequently Asked Questions

Does every extra prenatal visit qualify for separate billing?

No. The reason for the visit, the documentation, CPT rules, and payer requirements all factor in.

Does every complication visit require modifier 25?

No, only when a significant, separately identifiable E/M service is performed the same day as another procedure and the requirements are met.

When is modifier 24 relevant?

For unrelated E/M services during a surgical global period, not as a general modifier for unrelated care during pregnancy.

When can modifier 57 apply?

When an E/M service results in the initial decision for major surgery, supported by the medical record.

Are the global maternity codes disappearing?

Yes, effective January 1, 2027, replaced by phase-specific reporting for antepartum care, labor management, delivery, and postpartum care.

What is modifier TH and when is it needed?

ACOG recommends it on E/M-coded prenatal and postpartum visits to flag them as maternity-related. Some payers already require it ahead of the 2027 transition, so check individual payer guidance now.

Does every payer implement the transition identically?

No. Confirm individual payer policies before changing your billing workflow. Commercial payers, Medicaid programs, and Medicare Advantage plans can adopt changes on different timelines or add their own rules, so check each major payer's published policy and update claim edits payer by payer.

The Bottom Line

Global maternity billing simplified payment for routine obstetric care, but that shouldn't stop practices from reviewing charts for separately reportable services. Through 2026, follow the existing CPT framework while tracking payer-specific transition policies, including early modifier TH requirements. Starting January 1, 2027, a more granular phase-based system takes over.

The practical takeaway for revenue-cycle teams: skip the visit-count habit. Review what care was provided, document why, apply modifiers only when their requirements are met, and confirm payer rules before submitting. The transition is also a chance to strengthen the underlying workflow. Building in reliable chart review, payer tracking, documentation checks, and 2027 preparation reduces rework while capturing every eligible service accurately.

For QWay Healthcare, that means supporting OB/GYN practices well beyond claim submission, helping organize the coding, documentation, payer-review, and workflow processes needed as the maternity billing landscape changes.

External Resources

Related Articles

Modifier 57 vs. Global Surgical Period Rules: How General Surgery Claims Get Denied

top general surgery claim denials. Learn the exact rules for modifier 57 vs. 25, master 90-day global periods, and fix common coding errors.