This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule and the new maternity billing codes, released by the American Medical Association (AMA), will become effective as of this date. A list of all new, revised and deleted codes can be found on AMA’s website.
Transition Period-Starting Sept. 1, 2026
To support a smooth transition, beginning Sept. 1, 2026, NC Medicaid Direct and NC Medicaid Managed Care providers are encouraged to use Evaluation and Management codes (E/M 99202-99215) with the TH modifier, to indicate prenatal or postpartum care. These codes should be used for:
- All claims and documentation for beneficiaries presenting for their first prenatal visit after confirmation
- Antepartum visits where the delivery and/or the postpartum visit is anticipated to occur after Jan. 1, 2027.
In addition to the E/M codes, the appropriate ICD-10-CM code should be recorded including the weeks of gestation for verification. Documentation must support medical decision making or time consistent with Current Procedural Terminology (CPT) guidelines.
Services Completed Before Jan. 1, 2027
For pregnancies that culminate with a postpartum visit prior to Jan. 1, 2027, all current existing codes including global, 59425 (Antepartum care only; 4-6 visits) and 59426 (Antepartum Care only; 7 or more visits) may be billed.
Health plans may not require the use of individual E/M codes in lieu of current bundled codes for dates of service prior to Jan. 1, 2027.
Clinical Coverage Update
Clinical Coverage 1E-5 is being revised to reflect the updated information.
Contact
NC Medicaid Contact Center, 888-245-0179