How to Choose E/M Codes for Antepartum Visits in 2027

Starting January 1, 2027, routine antepartum visits will no longer automatically accumulate toward the traditional antepartum/global maternity code structure. Each antepartum encounter must be reviewed and reported using the E/M code that matches the service provided.

That changes how OB/GYN practices handle antepartum care billing. Codes 59425 and 59426 are being deleted, along with long-standing global maternity codes such as 59400 and 59510. In 2027, antepartum care moves to encounter-level E/M reporting.

For ob-gyn billing teams, this means the number of prenatal visits alone will no longer determine how antepartum care gets reported. Each encounter needs to be reviewed based on the setting, patient status when applicable, medical decision making (MDM), total time, diagnoses, and payer requirements.

What Changes for Antepartum Coding on January 1, 2027

In 2026, 59425 is used for 4–6 antepartum visits, while 59426 is used for 7 or more visits. If the patient has three or fewer visits, the appropriate E/M codes are used.

That changes on January 1, 2027.

The AMA is deleting 59425 and 59426. Starting in 2027, each antepartum visit will be billed separately using the appropriate E/M code. The code depends on where the patient is seen, such as an office, hospital, or telehealth visit.

The billing team will also need to look at the work done during each visit. Medical decision making (MDM) or total time can determine the E/M level, depending on the service and the applicable E/M rules.

This is part of the larger 2027 maternity CPT changes. The old global maternity structure is being split into separate parts: antepartum care, labor management, delivery, and postpartum care. The AMA has deleted 17 codes, added 12 new codes, and revised six codes for 2027.

For OB/GYN billing services, the main change is simple: starting in 2027, you cannot use the number of prenatal visits alone to decide how antepartum care is billed. Each visit needs to be coded based on the service provided. Here is the practical difference:

Antepartum billing	Through Dec. 31, 2026	Starting Jan. 1, 2027
1–3 qualifying antepartum visits	Individual E/M codes	Individual E/M codes
4–6 qualifying visits	59425	Individual E/M codes
7+ qualifying visits	59426	Individual E/M codes
Code selection driven by visit count	Often	No
MDM or time used for individual E/M selection	When E/M is reported	Yes
Telehealth encounter	Subject to applicable 2026 rules	Appropriate E/M based on service/setting and telehealth rules

Which E/M Codes Can Be Used for Antepartum Visits in 2027?

There is no new antepartum CPT code replacing 59425 or 59426. Starting in 2027, each antepartum visit is billed separately using the E/M code that fits the service provided.

For office or outpatient visits, this can include 99202–99205 for new patients and 99211–99215 for established patients, when appropriate. These are standard E/M codes, not new OB/GYN CPT codes. For quick reference, see our OB/GYN billing cheat sheet.

The code can be different when the patient is seen in a hospital or through telehealth. In 2027, the key is to look at where the service was provided and what happened during the visit, then choose the E/M code that fits.

Choose the Antepartum E/M Level by MDM or Time

In 2027, each antepartum visit is reported with the appropriate E/M code. The level can be based on medical decision making (MDM) or total time on the date of the encounter, following the applicable E/M rules. Each visit is reviewed separately.

Choose the E/M Level Using MDM

When using MDM, look at the problems addressed, data reviewed or analyzed, and risk of patient management.

Two visits for the same pregnancy can have different E/M levels. A routine visit may require less decision-making, while a visit for gestational hypertension, gestational diabetes, maternal anemia, multiple gestation, or fetal growth concerns may require more work.

The diagnosis alone does not determine the E/M level. The code should reflect what the provider actually evaluates and manages during that visit.

When Can Time Be Used

You can also select the E/M level using total time when the applicable E/M rules are met. This can include qualifying work such as reviewing records, counseling, care planning, documenting, and coordinating care.

If time is used, document the total qualifying time for the encounter.

What If the Pregnancy Crosses From 2026 Into 2027

This is an important point for OB/GYN medical billing teams.

For example, a patient has five qualifying antepartum visits between September and December 2026. She then has six more visits between January and March 2027.

The five 2026 visits are handled under the 2026 rules, so they can be reported with 59425. The 2027 visits are handled under the new rules, so each visit is reported separately using the appropriate E/M service.

The 2026 and 2027 visits should not be combined to decide whether 59425 or 59426 applies. The date of service determines which CPT year's rules apply.

How Should Telehealth Antepartum Visits Be Coded in 2027

Telehealth is one reason the new maternity structure matters.

The AMA says the revised structure allows antepartum care to be reported based on where the service occurs, specifically identifying office, hospital, and telemedicine as examples.

For a telehealth antepartum encounter, start by identifying the actual E/M service provided. Then review the payer's current requirements for telehealth coverage, modifiers, place of service, and technology.

Do not create one telehealth rule and apply it across Medicare, Medicaid, Medicaid managed care, and commercial plans.

The underlying E/M code may be correct while the claim still denies because the modifier or place of service does not match that payer's policy.

What Should OB/GYN Practices Change Before January 2027

Before January 2027, OB/GYN practices should review their EHR, encounter templates, charge capture, claim rules, provider documentation, and payer requirements.

The billing workflow should be ready to stop using deleted maternity codes, capture individual antepartum E/M charges, support E/M levels based on MDM or time, and handle office, hospital, and telehealth visits correctly.

Practices should also check how their system handles pregnancies that cross from 2026 into 2027, pregnancy-related ICD-10-CM codes, payer-specific requirements, and E/M billing patterns after the changes take effect.

The AMA says deleted codes are invalid for dates of service beginning January 1, 2027. Claims systems and clearinghouses should be updated before the new rules take effect.

If your practice needs help preparing for these changes, OB/GYN billing services can help review charge capture, coding workflows, payer rules, and claim setup before January 2027.

FAQ

What is the ICD-10 code for an antepartum visit?

There is no single ICD-10 code for an antepartum visit. The correct diagnosis depends on the reason for the visit, pregnancy status, and whether a pregnancy-related condition is being treated. 

What is the CPT code for antepartum visits?

Starting January 1, 2027, 59425 and 59426 are deleted. Each antepartum visit is reported separately with the appropriate E/M code for the service and setting.

For office and outpatient visits, this can include 99202–99205 for new patients and 99211–99215 for established patients, when those codes fit the encounter. Other settings use the appropriate E/M service for that setting. For related code references, see our OB/GYN CPT codes resource.

Can every routine prenatal visit be billed with the same E/M code?

No. Each antepartum visit is reviewed separately. The E/M code can change based on the work performed, including medical decision making (MDM) or total qualifying time.