Emmett Bernsohn
A revenue cycle guide for OB/GYN and women’s health leaders preparing for the January 2027 transition
The End of a 30-Year-Old Billing Model
For three decades, obstetric care has been paid for the same way: one bundled code, one lump payment, covering roughly 13 prenatal visits, delivery, and six weeks of postpartum care. It was simple. It was also increasingly out of step with how obstetric care is actually delivered today, with more screenings, more chronic condition management, more counseling, and more touchpoints between patient and practice.
On January 1, 2027, that model ends. The American Medical Association’s CPT Editorial Panel, acting on years of advocacy from the American College of Obstetricians and Gynecologists (ACOG), is deleting 16 global obstetric codes. In their place: individual E/M codes (99202–99499) for every prenatal and postpartum visit, each carrying the HCPCS “TH” modifier, while existing delivery-only codes remain in place for labor and birth. ACOG has recommended payers begin the shift for antepartum visits starting as early as September 2026, so many practices will feel this change before the calendar turns.
For OB/GYN and women’s health groups, this is the most significant reimbursement change in a generation. It is also, if practices prepare well, a chance to finally get paid for the full scope of care they already provide.
Why ACOG Pushed for This
Global billing was built for a simpler era of prenatal care. ACOG’s own position is direct: the bundled model no longer reflects the standard of care, and it created real financial strain for the ob-gyns delivering it. Providers absorbed the cost of managing complex, high-touch pregnancies at the same flat rate as straightforward ones. Unbundling is meant to correct that, paying more accurately for the work being done, and, as ACOG has stated, supporting more tailored, patient-centered care along the way.
That’s a mission women’s health practice would welcome. But the operational shift underneath it is significant, and it lands squarely on the revenue cycle team.
What Changes for AR and Cash Flow
Under the global model, a pregnancy generated one claim and, eventually, one payment event. Under the unbundled model, that same pregnancy generates a dozen or more separate claims across nine-plus months. Each carries its own coding requirement, its own documentation standard, and its own chance to be paid late, paid short, or missed entirely.
A few consequences practices should plan for now:
- More claims, more chances for leakage. Global codes buffered practices against minor under-coding. Every visit now stands on its own. A missed code or thin documentation is lost revenue, not a rounding error absorbed into a larger bundle.
- Cash flow becomes lumpier before it becomes fuller. Revenue that used to arrive as one predictable payment per pregnancy will now arrive in smaller pieces, spread across the entire prenatal and postpartum journey. Practices that don’t adjust their AR forecasting and staffing will feel a cash flow gap even as total reimbursement improves.
- AR days are exposed to more variables. With more claims per patient, more opportunities exist for denials, coding errors, and payer delays to stretch AR days out, right at the moment practices need faster payment cycles to fund the increased administrative load.
The Stakes, in Numbers
None of this is theoretical. Even under today’s simpler, bundled billing model, capturing what patients owe is already one of the toughest parts of the revenue cycle. Unbundling adds more claims, more statements, and more chances for that gap to widen.
- 65% vs. 20% Balances captured at time of service, with vs. without a structured process
- 54% of Americans are now on a high-deductible health plan
- 15–20% of practice revenue from patient responsibility
- 90 days until unpaid balances become difficult to recover
Source: MGMA, Patient Collections Benchmarks Report (2025); Kaiser Family Foundation, Employer Health Benefits Annual Survey (2025).
Layer in the added claim volume from unbundled maternity billing, and these numbers point in one direction: without the right payment infrastructure, more visits mean more room for balances to slip through.
Changes for the Patient
Patients feel this shift too, often without warning. A family that has budgeted for “one pregnancy bill” is now going to see a running series of statements, copays, and balances across nearly a year of care. Without a modern, patient-friendly payment experience, that adds up to more confusion, more calls to the front desk, and more balances that quietly age past the point where they’re easy to capture, at exactly the moment in a patient’s life when financial stress is the last thing they need.
The pattern is clear: practices with a deliberate, well-run patient payment process capture meaningfully more, and capture it sooner. Spread across a dozen new billing moments per pregnancy instead of one, the gap between a well-run process and an informal one compounds fast.
The two goals are not in tension. A billing model that supports clearer, timelier patient communication protects revenue for the practice and reduces confusion for the patient at the same time. The practices best positioned for 2027 will be the ones that treat financial clarity as part of the care experience itself, not an afterthought once the clinical visit ends.
What “Ready” Looks Like
Practices that come out ahead of this transition will be the ones that treat it as an infrastructure question, not just a coding question. Three capabilities matter most:
Flexible, exception-ready billing. With visit-by-visit E/M coding replacing a single global code, billing teams need the ability to generate and adjust individual patient bills on the fly, for the visit that doesn’t fit a template, the mid-pregnancy transfer of care, or the postpartum complication that falls outside the standard six-week window. Manual bill creation gives staff that flexibility without slowing down the front office.
A payment experience built for repeat billing. When one bill becomes a dozen, asking a patient to re-enter payment information every time is a recipe for missed payments and frustrated calls. Card on file lets a patient set up payment once, securely, and let it carry them through the full prenatal-to-postpartum journey, with fewer friction points for the patient and fewer manual follow-ups for staff.
A way to smooth cash flow. Unbundled billing spreads cost across many smaller moments instead of one larger one. Payment plan rollup lets practices consolidate what would otherwise be a scattered series of small balances into one manageable plan for the patient, protecting cash flow for the practice while keeping the payment experience simple and predictable for the family.
None of this replaces good coding and documentation discipline. That foundation still matters most. But the practices that pair strong documentation with the right payment infrastructure will convert this transition into the opportunity ACOG intended: fairer reimbursement, without pushing the administrative burden onto patients or front-desk staff.
The Bottom Line
The end of the global OB code is a policy change, but its real impact will be felt in AR forecasts, staff workflows, and patient statements. Practices that start preparing their billing and payment infrastructure now, well ahead of January 2027, will spend next year capturing more accurately for the care they provide, instead of chasing down the pieces of a bundle that no longer holds together.
