What the end of global maternity billing means for OB/GYN productivity pay

Medicare will adopt the unbundled maternity care codes from the American Medical Association (AMA) on Jan. 1. The Centers for Medicare & Medicaid Services released its final 2027 Medicare Physician Fee Schedule Nov. 4 without the 15 Medicare-only G-codes it proposed in July to preserve the global bundle, according to the American College of Obstetricians and Gynecologists (ACOG).

Under the new structure, prenatal care, labor management, delivery and postpartum care are reported separately, and each prenatal and postpartum visit is billed as its own evaluation and management (E/M) visit. ACOG says the Department of Health and Human Services will let health plans keep using the 2026 codes for pregnancies that begin in 2026 and end in 2027.

Carol Carden, CPA, ABV, ASA, CFE, managing principal of compensation valuation, planning and design at PYA, spoke with Medical Economics before the final rule came out, while Medicare's approach was still open. "I would not want to see a provider put their head in the sand, not think through this and then come Jan. 1 be faced with some pretty fundamental changes in how they have to bill for these services," she said.

Where the work RVUs go

Carden said the shift lands hardest on hospital-employed obstetrician-gynecologists (OB/GYNs) whose pay depends at least in part on work relative value units (RVUs). Private practices tend to pay physicians on collections, so the change shows up in revenue rather than in a productivity formula.

Under the global code, the physician is credited with all the work RVUs for a pregnancy, including prenatal and postpartum visits that advanced practice providers (APPs) or midwives performed. Starting in January, APPs and midwives bill their own visits. Each visit also carries a complexity level, and Carden said practices need to learn the documentation guidelines so they don't overcode and raise compliance risk or undercode and leave money on the table.

The restructuring is intended to be budget neutral overall, and Carden said the valuation assumes eight prenatal and two postpartum visits for an uncomplicated vaginal delivery. Even at those counts, PYA's modeling found about four fewer work RVUs than the 37 the global code credits today. Budget neutral "doesn't mean it will be budget neutral for each individual provider," Carden said.

New labor management codes let laborists and OB hospitalists bill for the hours they spend with a patient before delivery. Carden said PYA first expected that revenue to shrink the hospital subsidies many laborist programs depend on. But the delivery code now carries fewer work RVUs, and the modeling showed no material effect on subsidies.

How employers are handling 2027

Some employers plan to freeze OB/GYN pay at 2026 levels, let 2027 play out and then adjust conversion rates once they see actual productivity, Carden said. Others expect a small effect and are letting it flow through. For employers that adjust conversion rates up front, PYA recommends reconciling at six and nine months so a physician isn't overpaid or underpaid for a full year.

Carden also expects several years of noise in the compensation survey data used to test fair market value, since 2027 surveys will reflect 2026 pay and some employers are freezing at 2026 levels. The industry went through the same thing after COVID-19 and after the 2021 revaluation of office E/M visits.

What to ask for in a contract

Carden said employed OB/GYNs worried about a pay drop can ask their employer to freeze compensation at 2026 levels. If that's off the table, she recommended an amendment that reconciles pay at set points in 2027, such as three, six and nine months. "Either way, there's going to be a reconciliation guardrail in place to protect providers," she said.

PYA's free webinar on the 2027 maternity coding changes walks through scenarios for practices that use a laborist, a midwife or an APP.