Medicare Breaks Up the Pregnancy Bill

One code paid for a whole pregnancy. Starting in January, most of that money has to be billed visit by visit, and the practice that delivers the baby is no longer the only one who can collect.

For decades one billing code has covered an entire routine pregnancy. Code 59400 pays a practice for prenatal visits, the delivery, and recovery care afterward as a single charge.

Medicare prices physician work in units called work RVUs, and 59400 is worth 37.00 of them, or about $1,227 at the rate Medicare has proposed for 2027.

On January 1, 2027 the code is deleted, along with 16 other maternity codes.

What replaces it is already published. A committee at the American Medical Association reviews new codes and recommends prices to Medicare. It reviewed the restructured maternity codes in January 2026 and sent its numbers over in February.

A straightforward vaginal delivery with one day of labor is now billed as two codes.

Managing labor is worth a recommended 3.50 work RVUs. The delivery is worth 8.00. Together, 11.50, or roughly $381.

The other 25.50 points, about $846 and 68.9% of what the old code carried, have not been taken out of the system.

They have been split into individual office visits that now have to be written up and billed one at a time. The old code paid one practice for the whole pregnancy and nobody had to show what happened inside it.

Now every visit has to be documented and billed on its own, and collecting depends on whether you can produce that record.

So the practice that delivers the baby is no longer the only one who can reach the money.

The AMA's rules list video visits and virtual check-ins among the codes a provider can bill for prenatal care, and again for recovery visits after birth. A virtual prenatal appointment becomes something you bill for directly, rather than unpaid work folded into someone else's charge. Each insurer still decides whether to pay. But the wall is gone, and what replaces it is a contest over documentation between whoever is in the exam room and whoever is on the video call.

There will also be fewer visits to contest. The AMA committee priced the new codes against the old prenatal schedule from 2009, which assumed 13 visits worth 14.15 work RVUs. In the same document it notes that the American College of Obstetricians and Gynecologists replaced that schedule in April 2025, recommending 6 to 10 targeted visits for average-risk patients instead of the traditional 12 to 14. The old code paid the same whether a practice saw a patient 8 times or 14, quietly absorbing both undercharging and extra work.

Nothing absorbs either now.

A practice following current guidance sees roughly half the appointments its payment was built on and makes up the difference only by recording each one at the right level.

Medicare saw the same gap and moved, proposing to drop four visits from its estimate and shift that value into the labor and delivery codes. ACOG welcomed the increase publicly.

It also objected to a second option Medicare is weighing, which would create 15 new codes preserving the old bundled system on the reasoning that switching might be too disruptive. Comments on the rule, published July 16 as CMS-1848-P, close September 14, with a final decision expected in early November.

Two answers to the billing question surfaced in a single week.

On August 4, Ouma Health, a maternity telemedicine company, announced it had acquired a multisite maternal-fetal medicine practice led by Tamara Takoudes, MD, adding in-person locations across Connecticut, Massachusetts, Maine and New Hampshire. It was the company's second practice acquisition in ten months, following Sunny Day MFM and clinical assets of Boston MFM in October 2025.

On August 6, Millie, a midwife-led clinic with locations in Berkeley and San Jose, announced it was joining UCSF Health Medical Foundation's clinically integrated network, which gives it access to UCSF's payer contracts. Buying the practice and joining the network are different routes to the same destination, which is becoming an entity that can bill.

Who signs the paychecks is becoming a question about whether the bill gets paid.

Medicare proposes paying for remote patient monitoring only when the staff doing it work directly for the practice, and not when they work for an outside company. Monitoring blood pressure for dangerous high blood pressure in pregnancy is one of the few corners of women's health where insurers reliably pay, and most companies in it supply monitoring staff to medical practices.

Recovery care moves the opposite way from prenatal.

Federal law requires Medicaid to cover only 60 days after birth, but the American Rescue Plan let states extend that to 12 months and the Consolidated Appropriations Act of 2023 made the option permanent.

As of July 2024, 46 states and the District of Columbia had extended it, and KFF's live tracker was last updated July 15, 2026. Postpartum visits become separately billable at the same moment most states have stretched the covered window from two months to a year.

None of this hinges on Medicare covering births. Medicaid does the paying.

In 2024, 40.2% of mothers had Medicaid at the time of birth, according to natality data compiled by March of Dimes. The code book binds every insurer, so deleting the bundled codes changes commercial and Medicaid billing regardless of what Medicare decides about its own prices. And because most Medicaid programs and private contracts set rates by copying Medicare's, the number finalized in November spreads into the plans covering the roughly 3.5 million births in US hospitals each year.

The rule never says menopause.

It also never says hormone, contraception, postpartum, or perinatal, a word search Forbes ran on August 7. Lined up against what is actually selling, that looks less like neglect than like a border.

The strongest-performing corners of women's health right now are mostly paid out of pocket and delivered by video, with a short road from launch to revenue and no billing code required.

What is being repriced is the insured side, and per Dealroom's femtech data, computed by the aggregator rather than verified against original announcements, that is also where funding has fallen hardest over the past two years.

The AMA committee ran its budget math for the country. Practices will find out in January what it did to them.

This article is for informational purposes and is not medical advice.