ACOG Statement on New Maternity Codes in the 2027 Medicare Physician Fee Schedule Proposed Rule

The following statement is from Camille A. Clare, MD, MPH, CPE, FACOG, president of the American College of Obstetricians & Gynecologists (ACOG):

"ACOG thanks CMS for their inclusion of the AMA's new obstetric CPT codes in the 2027 Medicare Physician Fee Schedule proposed rule. We are also pleased that CMS increased the proposed value for the new labor and delivery codes. These new codes represent a critical step in modernizing obstetric coding and billing and setting a foundation for the future of maternity care that is financially sustainable, data-driven, quality-focused and, overall, a better reflection of how care is delivered today.

"However, ACOG is concerned that CMS is also considering the creation of 15 new HCPCS G-codes for 2027 that would reflect the existing, inadequate global coding and payment structure for maternity services. CMS's rationale is that these codes would reduce concerns that adoption of the new obstetric codes from the AMA and ACOG would be disruptive. Yet implementing these G-codes, even for a year, would cause even greater disruption and confusion by increasing administrative burden for obstetric clinicians and practices and forcing them to learn and operate under two separate billing structures. Specifically, if the G-codes are implemented, patients will be divided into two groups: those whose insurers decide to unbundle maternity care and those whose insurers choose not to. This presents a real risk of worsening obstetric care disparities when maternal mortality and morbidity remain unacceptably high and creates a barrier to continued progress to improve maternal health outcomes.

"The new obstetric codes intentionally align with ACOG's new approach to prenatal and postpartum care, which reflect the best medical evidence to better meet the needs of patients by allowing customization and more focused attention on social and medical needs instead of the current one-size-fits-all model.

"The G-codes would also undermine efforts to increase price transparency for patients, whereas the new payment structure will allow for a better understanding of pricing and reimbursement for individual obstetric services that is not possible with the bundled system.

"CMS has the opportunity to create better outcomes and more transparent billing for pregnant patients by transitioning to the new obstetric codes from the AMA and ACOG. Health plans have been given ample time to facilitate this transition, and our members are currently working toward it. We urge CMS to adopt the new obstetric codes and make a clean break by not implementing the proposed G-codes. Otherwise, we will remain stuck in the current system, instead of moving forward toward true value-based maternity care."