CMS finalized its fee schedule rule, following clinical guidance from the American College of Obstetricians and Gynecologists and the American Medical Association. The policy shifts approximately 15% of relative value units from prenatal visits directly to labor and delivery. The reform deletes 17 legacy global Current Procedural Terminology codes, introduces 12 new procedural codes, and revises nine existing procedural codes governing specialized obstetric care. Health Management Associates noted in an analytical brief published on November 11 that unbundling services and payment across the course of care may shift additional reimbursement toward providers that offer labor and delivery services.
Historically, bundled global billing paid a single flat fee covering prenatal visits, delivery, and postpartum care. When a mother received prenatal visits from a clinic but delivered at a regional hospital, splitting payments created substantial billing complexity and underfunded delivery units. By reallocating 15% of total relative value units specifically to labor and delivery codes, CMS intends to stabilize hospital obstetrics departments. CMS clarified that the adjustment is not intended to reduce the clinical volume of prenatal checkups provided to expecting mothers.
CMS decided against creating temporary HCPCS G-codes it had initially proposed in earlier draft rulemaking. CMS will monitor real-world claims under the 12 new unbundled codes before considering any future bundled models. More than 100 rural obstetric units closed nationwide between 2020 and 2025, creating maternity care deserts across southern and western states.
Medicaid finances more than 40% of all births in the United States, and state Medicaid programs frequently incorporate Medicare relative value weightings into their fee schedules. The unbundled payment structure will take effect for services provided beginning January 1, 2027.
