During the 2026–2027 transition, antepartum visits are reported per encounter with office/outpatient E/M codes — 99202, 99203, 99204 or 99205 for new patients and 99212, 99213, 99214 or 99215 for established patients — selected by medical decision making or total time. Visits furnished in 2026 may still use 59425 or 59426 when the 2026 visit count reaches four or more.
That is the whole rule in two sentences. The hard part is operationalizing it: choosing levels, documenting each visit so it stands alone, and handling pregnancies that straddle December 31. This post covers all three.
Which patients this applies to right now
Per the AMA’s transition guidance, antepartum visits furnished in 2026 are reported with 59425 (four to six total antepartum visits), 59426 (seven or more) or E/M codes when there are fewer than four visits — counting only the visits that occur in 2026. Everything furnished on or after January 1, 2027 is E/M, because all antepartum bundle codes are deleted from the CPT 2027 code set (AMA CPT Education Brief, “Maternity Care Services 2027 – Antepartum Transition Reporting,” April 24, 2026).
Practically, the AMA brief sorts your OB panel by due date: pregnancies whose first 10-week visit happened early in 2026 will finish under the old global and antepartum codes, while pregnancies with a first 10-week visit on or after September 1, 2026 will generally have three or fewer visits before year-end and should be reported with E/M codes from the start. ACOG’s coding guidance likewise directs that, beginning September 1, 2026, the first prenatal visit after pregnancy confirmation be billed with an E/M code and appropriate ICD-10-CM codes (ACOG, “Payment for Obstetric Services” coding library, 2026).
Choosing the E/M level: MDM or time
Standard E/M rules apply to antepartum encounters — there is no special obstetric level-selection method (American Medical Association, “CPT 2027 Maternity Care Services code changes,” updated July 8, 2026). Under the AMA’s office/outpatient E/M framework, you select the level using either medical decision making (MDM) or total time on the date of the encounter (AMA, “CPT Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services Code and Guideline Changes,” 2023 descriptors and guidelines).
The current CPT descriptors set minimum total-time thresholds that must be met or exceeded:
| Code | Patient | MDM level | Total time on date of encounter |
|---|---|---|---|
| 99202 | New | Straightforward | 15 minutes or more |
| 99203 | New | Low | 30 minutes or more |
| 99204 | New | Moderate | 45 minutes or more |
| 99205 | New | High | 60 minutes or more |
| 99212 | Established | Straightforward | 10 minutes or more |
| 99213 | Established | Low | 20 minutes or more |
| 99214 | Established | Moderate | 30 minutes or more |
| 99215 | Established | High | 40 minutes or more |
For a routine, uncomplicated prenatal check, expect low-level established-patient visits to be common. Visits managing gestational diabetes, hypertensive disorders, or abnormal findings — where the physician orders and interprets tests, weighs treatment risk, and coordinates with MFM — will support higher MDM. Report the level the documentation earns, not a blanket default: payers will see a sudden stream of identical codes from OB practices, and uniform level distribution is an audit flag.
Location also matters now. The restructure was explicitly designed so the E/M code reflects where the patient is — office, hospital or telehealth (AMA, July 8, 2026). An antepartum check done as a telehealth visit is reported with the applicable telehealth-eligible E/M code and payer-required modifiers, not folded silently into a bundle.
Documentation: every visit stands alone
Under the global package, a flow-sheet entry was enough because payment came at delivery. Under per-encounter E/M, each note must independently support its code:
- Interval history — what has changed since the last visit, including symptoms and compliance.
- Problems addressed — routine pregnancy surveillance versus complications actively managed at this visit.
- Data — labs, ultrasounds and monitoring reviewed or ordered, and outside records considered.
- Risk and plan — medication decisions, escalation to MFM, delivery planning discussions.
- Time, if that is the selection basis — total qualifying time on the date of the encounter, including non-face-to-face work.
Pair each claim with the appropriate pregnancy supervision diagnosis (the Z34 series for supervision of normal pregnancy or the O09 series for supervision of high-risk pregnancy, plus codes for any complications managed), sequenced per ICD-10-CM guidelines.
Deliveries spanning the boundary: three scenarios
Due March 2027, first visit October 2026. The patient accrues perhaps two or three visits in 2026 — report each with an E/M code. All 2027 antepartum visits are E/M. Delivery and labor management are reported with the new 2027 codes.
Due January 2027, care started June 2026. The 2026 visits will likely total seven or more; report 59426 for the 2026 antepartum care, then E/M codes for any January visits, plus the new delivery-phase codes. You will not know whether 59425 or 59426 applies until the year closes, so the AMA recommends identifying affected patients by anticipated delivery date now rather than guessing early (AMA transition brief, April 24, 2026).
Delivering in December 2026. Nothing changes — the global codes remain valid for care completed in 2026.
The operational takeaway: hold the 2026 antepartum bundle charge until year-end for boundary patients, and make sure your billing system can suspend and release those claims cleanly.
Watch each payer’s implementation
The CPT rules above are the reporting standard, but payment policy is still moving. CMS proposed values for the new codes in July 2026, with final values due in November, and is separately consulting on 15 possible G-codes that would preserve global-style payment for Medicare (CY 2027 Physician Fee Schedule proposed rule, CMS-1848-P, Federal Register, July 16, 2026 — comments close September 14, 2026). Commercial payers are publishing their own transition bulletins. Track them payer by payer; do not build one workflow and assume universal adoption on January 1.
Our coding team maintains transition cheat sheets and E/M level guides in the AMS resource library.
Get the transition workflow built for you
AMS Solutions, Inc. — physician-founded in 1992, with AAPC-certified coders working under a signed BAA — is building antepartum E/M workflows for OB/GYN and family medicine clients right now. If you want the level-selection logic, claim-hold rules and payer tracking handled, learn more about our medical billing services.
