CPT 59400 is a valid code that will be replaced January 1, 2027. It has three new global maternity codes (59510, 59610 and 59618), ending a long-standing model that combined pregnancy care into a single claim. Delaware obstetric practices have about nine weeks to get charge entry, payer instructions, and fee schedules in sync for four different levels of care.
Gynaecology practices have a different burden. Annual exams turn into problem visits, IUD and implant claims need matching device codes, and each of Delaware’s three Medicaid managed care plans has its own rules. This guide explains how OB/GYN billing services work in Delaware, what the 2027 change does to claims, and where practices lose money today. Claimstone Billing specialties bring 10+ years of collective experience to this work, and the points below come from what actually gets claims paid.
Why is pregnancy care hard to bill
Most specialities bill an encounter and move on. Obstetrics bills for nine months. The legacy global code combined the traditional thirteen antepartum visits, delivery, and postpartum care into a single service, which the AMA claims simplifies billing but conceals how much care varies from patient to patient. Real pregnancies don’t follow the script. Patients may change practices, seek treatment at another hospital, or consult a clinician outside of their current group. Every handoff resets the codes that a practice is capable of reporting.
Gynaecology now provides same-day services, supplies, and in-office procedures, with each combination subject to payer requirements. A claim may appear impressive at the front desk, but it can still fail due to a modifier, diagnosis link, or missing device code.
How Delaware’s payer mix shapes the work
Medicaid financed 43% of Delaware births in 2023, according to KFF’s state data. For an obstetric practice, Medicaid rules are daily work.
State Medicaid agencies must establish a submission deadline no later than 12 months from the date of service, as required by federal regulations. Plan contracts can impose shorter windows, so a payer-by-payer deadline table is worth more than anyone’s memory.
Commercial payers are on the move, too. Highmark said it is reviewing its policies and systems for the 2027 maternity changes and will notify providers of any changes that may affect claim submission. National summaries do not dictate the construction of a Delaware claim for claims dated on or after January 1. Payer instructions do.
The 2027 maternity coding overhaul in plain terms
The AMA’s CPT Editorial Panel deleted 17 maternity codes, added 12 and revised six, effective Jan. 1, 2027. The following codes have been deleted: 59400, 59510, 59610, 59618, 59425 (antepartum only), and 59426 (antepartum only). Now, care is divided into four phases.
| Phase | Through December 31, 2026 | From January 1, 2027 |
| Antepartum | Global package, or antepartum-only codes 59425 and 59426 | One E/M code per encounter |
| Labour management | Inside the global package | New codes 59080 to 59083, reported once per calendar day, at simple and complex levels |
| Standard delivery | worldwide package or delivery codes | New delivery codes for vaginal delivery, vaginal delivery after caesarean and caesarean |
| Postpartum | Global package or a postpartum care code | One E/M code per visit; routine same-day care is bundled into the delivery code. |
Three smaller changes matter for charge entry. Third-degree and fourth-degree laceration repair, hysterectomy after caesarean, and uterine tamponade now have their own codes. Labour management is by calendar date, so a long admission produces a queue each day. And the delivery codes are for delivery only, while labour management is listed separately.
Starting September 1, 2026, ACOG has asked health plans to accept E/M codes for antepartum visits with the modifier TH to identify maternity care. Each plan decides whether or not to honour that request.
Pregnancies that cross January 1 and the Medicare question
A patient who begins prenatal care this autumn delivers in 2027, after the global code is gone. The AMA’s transition-date FAQ keeps 2026 dates of service on 2026 rules: three or fewer antepartum visits in 2026 take individual E/M codes, four to six take 59425, and seven or more take 59426. Each antepartum visit in 2027 is an E/M encounter. You don’t have two years colliding because you have a written rule for each pregnancy in order of due date.
Medicare adds a wrinkle. CMS released its proposed rule for the CY 2027 Physician Fee Schedule on July 14, 2026. It adopts the new CPT codes and also proposes 15 HCPCS G-codes that would keep a global payment path for Medicare. ACOG urged CMS to drop the G-codes and end the global payment path. The AMA expects the final rule in early November, so any model for the Medicare fee schedule remains a draft until then.
Gynaecology claims: where payments slip
The first leak is in preventive visits. HRSA’s women’s preventive services guidelines require most non-grandfathered plans to cover well-woman visits and contraception without cost sharing. If the same visit is for a different problem, problem-orientated E/M requires documentation to indicate a separate service, and modifier 25 is required by the payer. Without it, the first service eats up the second, and the practice eats up the work.
The second is contraception procedures. The LARC programme coding guide at UCSF lists 58300 for IUD insertion and 11981 for implant insertion, with the device billed separately using an HCPCS J-code. The insertion is not coded separately from the counselling service. Modifier 25 is attached to a separate E/M only if it was significant and separately identifiable.
Documentation and diagnosis coding under per-visit billing
The per-visit billing shifts the weight from the delivery claim to the prenatal chart. AMA guidance says “medical decision-making time” should be documented for every prenatal visit with a due date on or after January 1, 2027, so the correct E/M level can be chosen. A templated note with no decision-making detail gives a coder nothing to support a higher level.
Diagnosis codes need the same attention. The ICD-10-CM guidelines say a Z34 code for supervision of normal pregnancy is listed first and is never paired with a code from the obstetrics chapter. A Z3A code for weeks of gestation can follow it. A high-risk visit works the other way: the complication code leads, and the Z34 code stays off the claim.
Hospital work changes shape as well. Labour management is a daily code, and a continuous visit that crosses midnight counts as one service reported on one of the two dates. Under the new structure, subsequent hospital care codes cover each day after delivery until discharge.
Where Delaware OB/GYN claims deny, and how to stop it
Five denial sources show up again and again in obstetric and gynaecology work. Eligibility lapses between visits cause the first. A deleted global code sent on a 2027 date of service causes the second, because no valid code sits behind it. A missing modifier 25 on a same-day service causes the third, and a device code without its insertion code causes the fourth. Missed filing windows during claim rework caused the fifth.
Each has a fix at the front end. Eligibility is verified at the time of scheduling and check-in. The claim scrubber will receive a 2027 code list prior to the first January claim. Modifier and device-code rules sit in the charge entry template, where staff cannot skip them. The payer deadline is on every single line in the rework queues, so a denial worked in week six doesn’t die in month thirteen.
What a billing partner should deliver
A billing partner is measured by four key metrics: first pass acceptance, denial rate, days in accounts receivable, and net collections. For the 2027 transition, that begins with charge entry rebuilt around the four phases and tested on real claims before the first January encounter. The rules for each of the three Medicaid plans, Highmark and all other commercial contracts are codified once and applied to every claim. Each denial comes with a reason, a fix and a resubmission within the filing window. Monthly reports show denial reasons by payer so you don’t make the same mistake for a year. The benefit on the practice side is real: fewer write-offs for missed deadlines and a monthly look at what each payer really pays.
Four questions provide a clear view of practices across billing companies. How will the 2027 maternity codes be integrated into charge entry? Who do the denials work for, and how fast? How often do I have to file with each payer? What does the monthly report say?
Frequently asked questions
1. What does a billing company do for an obstetric and gynaecology practice?
It manages charge capture, claim filing, payment posting, denial tracking, patient statements, and reporting. It also monitors each pregnancy across four stages for obstetrics, ensuring that every service is billed to the appropriate payer using the correct code.
2. Can practice continue to bill the global obstetric code for a delivery that occurs in December of 2026?
Indeed. According to AMA guidance, a delivery that occurs in November or December 2026 should be reported using the appropriate global code, such as 59400, irrespective of whether postpartum visits occur in 2027. Subsequent visits are classified as E/M. Some plans have put their regulations into effect, so it’s wise to reach out to each one before the end of the year.
3. Will the new maternity codes change what practices get paid?
The values the RUC recommended to CMS were budget neutral, according to the AMA. Georgetown’s Center for Children and Families notes that budget neutrality across the system does not mean the same result for every provider. Each practice’s outcome depends on its service mix and payers, and CMS has not yet finalised its value.
4. Is there 12 months of postpartum coverage under Delaware Medicaid?
Yeah. In June 2023, Delaware extended Medicaid coverage for new mothers from 60 days to 12 months after birth. Medicaid postpartum and contraception visits are billable for that year, and eligibility should be verified at each visit.
5. How long does a Delaware insurer have to pay a clean claim?
One month. Delaware Regulation 1310 requires a carrier to pay, part-pay or deny in writing or request specific clinical information within 30 days of receipt of a clean claim. The Commissioner may order interest on late payments. The rule does not apply to Medicaid plans, which have their timelines under federal rules and plan contracts.
6. Do the 2027 changes affect gynaecology-only practices?
The coding stays the same. Every deleted, new, and revised code sits in the maternity range, and codes such as 58300 and 11981 are not on the AMA’s list. Payment is a separate matter: CMS proposed a 2027 conversion factor of $32.84 for non-qualifying clinicians, down 1.68%, which applies to every speciality.
7. How much does it cost to outsource OB/GYN billing?
Prices are dependent on the contract. The models include a flat fee or a percentage of collections, billed monthly. The real comparison is net collections after fees, not just the rate.
8. What does a billing company require to start?
Current payer contracts and fee schedule, 12 months of denial and A/R reports, credentialing and enrolment documents, and access to the EHR or practice management system.
Next step for Delaware practices
January 1 will not move. Practices that rebuild charge entry and payer instructions in November and December will start in 2027 with clean claims, while practices that wait risk spending the first quarter reworking denials. A call with Claimstone for Billing this week gets the payer-by-payer plan written before the first January claim goes out.