For decades, maternity care in the United States has generally been billed through one bundled fee covering prenatal visits, delivery, and postpartum care. Effective Jan. 1, 2027, the American Medical Association will replace that model with itemized codes that allow providers to bill for each visit and service as care is delivered.
The change may create new cost and administrative considerations for employers. Self-funded plans could see more claims, less predictable monthly costs, and higher processing expenses. Fully insured plans may experience the impact later through renewal pricing. Employees may also face more frequent cost sharing for nonroutine services, particularly under high-deductible health plans.
Our latest bulletin explains why maternity billing is changing, how the impact may differ by funding arrangement, what the shift could mean for employees and access to care, and steps employers can take now to review existing benefits, assess plan design, and communicate clearly with employees.
This Compliance Update is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
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