Expecting a baby in 2027? New billing rules could affect your costs
If you’re expecting a baby in 2027, the way your pregnancy care is billed could look a little different.
Beginning in January, new billing codes will replace the longstanding system that bundles most prenatal care and delivery services into a package. Instead, providers will be able to bill for individual services, creating a more itemized approach to pregnancy care.
It’s a change that many OB-GYNs have pushed for, but some say the changes could eventually lead to higher costs in an already expensive area of health care.
What’s really changing?
Under the current system, billing codes for pregnancy and delivery are bundled, with the number of prenatal visits per mother set at 13. Whether an expectant mother attends all 13, fewer, or more, everyone is billed the same way.
The new codes approved by the American Medical Association move toward a fee-for-service model. In practice, that means providers will have more flexibility to bill separately for prenatal visits, remote monitoring, postpartum care and other services that previously fell under broader bundled payments.
The changes also affect labor and delivery billing.
Lisa Hofler, a member of the American College of Obstetricians & Gynecologists (ACOG) committee that developed the new codes, told CBS News that the current system often fails to account for major differences in the amount of care patients receive.
“If someone comes in for a birth, no matter how long or how short their labor or how complicated or uncomplicated their delivery, the global reporting is the same because we only have one code,” Hofler said.
Why make the changes?
The ACOG says the new coding structure reflects the reality of modern maternity care.
“The current payment methodologies simply no longer reflect the care being provided today or the care ob-gyns will provide in the near future,” ACOG CEO Sandra E. Brooks said in a statement. “This includes the increasing use of home monitoring and telehealth and additional monitoring needed in the postpartum period for mental health conditions, hemorrhage, and cardiac conditions, which are the leading causes of maternal deaths.”
Will patients pay more?
That remains one of the biggest unanswered questions.
ACOG says most patients should not expect any cost increases because the Affordable Care Act requires most health plans to cover preventive maternity care at no cost to members.
However, “there will continue to be charges for labor, delivery, and other services not considered preventive care,” the ACOG said.
Some health policy experts say service-based fees could lead hospitals and medical professionals to push for more expensive services. It remains unclear, however, how insurers will handle those costs and whether any increases would ultimately be passed on to the patients.
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Ella Rae Greene, Editor In Chief
