Maternity Care Billing Structure FAQ
Beginning January 1, 2027, the national CPT coding structure for maternity care is changing. Instead of maternity care being billed primarily as one bundled episode, different phases of care will be reported separately. Because insurance plans are still preparing for the new structure and patient financial impact will vary by plan, EvergreenHealth is temporarily pausing maternity cost estimates beginning September 15, 2026.
We know you may have questions about your costs, the estimate you've already received or your ongoing care. The questions below address the topics we expect to hear most often.
Frequently Asked Questions
What's changing on January 1, 2027?
Starting January 1, 2027, the national billing structure for maternity care is changing. Instead of one bundled charge for your whole pregnancy, care will be billed in phases: prenatal visits, labor management, delivery and follow-up care.
Why is this changing?
The current billing codes have been in place for decades and do not fully reflect how maternity care is delivered today, with care teams that may include physicians, midwives, hospitalists and other clinicians. The American Medical Association updated the codes to better reflect modern maternity care.
Did EvergreenHealth decide to make this change?
No. This is a national CPT coding change from the American Medical Association. Health care organizations and providers that use CPT codes will need to transition to the new structure, including EvergreenHealth.
Is this because of a new law?
The billing codes themselves come from the American Medical Association. We'll share more as we have confirmed details about how other rules connect to the transition.
Does this affect everyone, or just certain insurance plans?
The coding change is national, but insurance plans are taking different approaches to how they will process and reimburse maternity services. We'll share more as plans and federal guidance are finalized.
Why can't I get a cost estimate for my maternity care right now?
Insurance plans are taking different approaches and are still finalizing how they'll handle claims under the new billing structure, so we're temporarily pausing maternity cost estimates starting September 15. We don't want to give you a number that might not be accurate when the new codes are in place.
Does that mean you don't know what my care costs?
We don't yet have enough information to estimate your individual out-of-pocket costs because insurance plans are taking different approaches and are still finalizing how they'll apply the new coding changes.
When will estimates come back?
We don't have a firm date yet. We'll share updates as soon as we have enough reliable information to provide accurate estimates.
I already got an estimate before September 15. Is it still good?
We want you to have the most current information. Keep your estimate for reference and contact your insurance plan to confirm how your coverage and expected out-of-pocket costs may apply to care in 2027.
Can I get an estimate today after September 15?
Maternity estimates are temporarily paused. Your care and appointments are not affected, and we'll let you know when estimates are available again.
Is my care changing because of this billing update?
No. This coding and billing transition does not change your care plan. Please continue your appointments and follow the care plan you and your care team have established.
Will my costs go up or down?
That will depend on your specific insurance plan. We recommend contacting your insurance plan directly with questions about coverage and expected out-of-pocket costs.
Will I get billed after every visit instead of one bill at the end?
The national CPT structure is moving away from the current global maternity codes and toward separate reporting for different parts of maternity care. How that translates to your statements and how your insurance plan processes those services may vary. We'll share more information as payer guidance becomes clearer.
I'm pregnant now and will deliver in 2027. Does this affect me?
Your care plan is not affected. Because your maternity care crosses the transition into 2027, how services are billed may depend on timing and your insurance plan. Your care stays the same.
Does this affect Medicaid patients differently?
We don't have confirmed EvergreenHealth-specific guidance for every Medicaid plan yet. Please contact your insurance plan directly with questions about how your coverage may apply.
