Opinion: Good riddance to bundled ‘global’ maternal care billing

OpinionFirst Opinion Good riddance to bundled ‘global’ maternal care billing New fee-for-service maternity care billing will help patients, physicians, and public health Manage alerts for this article Email this article Share this article By Camille A. Clare and Lisa G. HoflerJuly 23, 2026 Clare is president of the American College of Obstetricians & Gynecologists. Hofler is the ACOG adviser to the CPT Editorial Panel and a member of ACOG’s Committee on Health Economics and Coding. A change is coming to the codes OB-GYNs use to bill for maternity care services: Starting Jan. 1, 2027, we will shift from a bundled “global obstetric payment” to a fee-for-service model. This change impacts almost every U.S. family with a pregnancy. Under the current system, families receive a bill that does not distinguish the actual prenatal and postpartum costs from labor and delivery, which makes things incredibly confusing for patients. In fact, the bundled payment’s impacts have been widespread: It has complicated billing for patients and clinicians, limited access to care, cut back the ability to provide patients with more personalized care, and slowed progress in better understanding U.S. maternal health outcomes.Advertisement In the current bundled payment structure, patients receive unclear and inconsistent cost-sharing information. Federal law bars most health insurance plans from charging patients for prenatal visits, screenings, and some postpartum services. Today, roughly 93% of U.S. health insurance plans are not allowed to require cost sharing or copayments for preventive services such as prenatal visits or screenings. Counterpoint New billing codes are likely to raise maternity care costs Read the essay However, the global obstetric payment includes prenatal care, labor and delivery, and postpartum care together in one bundle. That bundle makes it difficult to determine which amount falls under the law, such as prenatal care and screenings, and which amount, including hospitalization and delivery, should have a copayment applied. And without oversight, some health insurance plans have been calculating copayments inconsistently and without transparency. It is not uncommon for health plans to erroneously charge copays or other cost sharing without calculating what preventive prenatal care should be exempt, and this has disadvantaged patients. The new code structure will ensure there are no copayments for prenatal visits, screenings, and qualifying postpartum visits. Each service will be billed separately, which means that patients will know exactly what they’re being charged and by whom.Advertisement However, cost sharing won’t go away for ultrasounds, lab tests, and labor and delivery, meaning patients will still be responsible for those copayments and deductibles. Whether those costs go up will be largely dependent on insurance companies, not clinicians. Complicated births that require, for example, extended time laboring will now be differentiated and might cost more, while uncomplicated births will cost less. Overall, this change should not affect insurance companies’ bottom lines, and therefore patients also should not have to pay more. The goal has always been to create a transparent payment system, collect meaningful data to battle maternal mortality and morbidity, and to pay obstetric clinicians for the work they are actually providing. Health plans are the ones that set copays, cost sharing, and deductibles for non-preventive services, and this new system will provide transparency about which costs health plans ultimately decide to pass on to patients. Outside of issues concerning cost, the global obstetric payment has also dramatically diminished access to care, especially in rural areas. Under the bundled system, only one payment is made, typically to the delivery clinician. When pregnant people with serious complications at a rural hospital require transfer to a higher-level facility, their local hospital and prenatal care clinician lose funds. Transfers from rural facilities occur in more than 25% of births. It is not a coincidence that now less than half of rural hospitals still have labor and delivery units in their communities. The new system will provide some relief by allowing rural hospitals and clinicians to collect payment for the care they provide. Additionally, the global obstetric payment assumes that all patients need the same amount and type of care. However, the American College of Obstetricians and Gynecologists (ACOG), which we are both part of, now recommends “tailored prenatal care,” factoring in medical, structural, and social determinants of health (e.g., where someone lives, their ability to pay for food and childcare, access to transportation).Advertisement The new payment structure aligns with this type of individualized care. People with low-risk pregnancies might need fewer in-person visits, or perhaps someone with a birth complication might require more postpartum care. OB-GYNs should more readily utilize other types of visits such as telehealth and home monitoring for those who may, for example, live in remote areas. The new approach more easily facilitates team-based care and allows for time spent on counseling, mental health screenings, and referrals to address unmet social needs. These types of changes will measurably impact health care inequities and outcomes. When the global obstetric payment was created, it was designed for patients with uncomplicated pregnancies managed by one physician or practice for the entire pregnancy. But maternity care, and the way that care is delivered, has changed dramatically over time. Patients change OB-GYNs, switch insurance plans, see various specialists during pregnancy or move to a different city or state, and the global obstetric payment makes these very common life events incredibly difficult for health researchers to study. Frankly, the bundled payment hasn’t improved maternal outcomes, but it has prevented us from understanding what care moves the needle. New codes mean that researchers will soon have access to a wealth of clinical data, including length of labor, number of prenatal or postpartum visits, and prevalence and management of pregnancy complications. The new data will help inform quality and safety improvements and new models of care aimed at preventing severe maternal harm. ACOG has been working hard to educate OB-GYNs about the new coding structure and how to incorporate it into their practices. Patients also deserve the full picture on the new billing system and what it will mean for them. While change can be unsettling, the new codes were designed with the intention of creating a transparent system where both patients and clinicians can thrive. Camille A. Clare, M.D., M.P.H., is president of the American College of Obstetricians & Gynecologists. Lisa G. Hofler, M.D., M.P.H., M.B.A., is the ACOG adviser to the CPT Editorial Panel and a member of ACOG’s Committee on Health Economics and Coding.Advertisement Letter to the editor Have an opinion on this essay? Submit a letter to the editor. health care costs, Health insurance, Physicians, reproductive health Submit a correction requestReprints Camille A. Clare Lisa G. 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