Unbundling Global Maternity Services
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Governs billing transition from global maternity CPT codes to an unbundled, phase-based structure for New Mexico Medicaid providers for deliveries on or after January 1, 2027.
CMS and AMA will eliminate all global maternity codes and replace them with an unbundled, phase-based structure effective January 1, 2027.
Specific transitional billing instructions tied to timing of first 10-week prenatal visit between May 15 and September 1, 2026.
For deliveries prior to January 1, 2027, continue billing under current guidelines.
Transitional Coverage Criteria
Transitional billing criteria
Billing instructions based on timing of the first 10-week prenatal visit for pregnancies delivering on or after Jan 1, 2027:
Birth center billing guidance
Additional site-specific billing note:
Transitional and Legacy Codes
| 59400 | global maternity code (example of codes being eliminated) |
| 59510 | global maternity code (example of codes being eliminated) |
| 59610 | global maternity code (example of codes being eliminated) |
| 59425-59426 | global maternity codes (examples of codes being eliminated) |
| 59426 | Antepartum care only; 7 or more visits (use for first 10-week visit between May 15 and July 14, 2026) + delivery only |
| 59425 | Antepartum care only; 4 or 6 more visits (use for first 10-week visit between July 15 and Aug 30, 2026) + delivery only |
| E/M + TH modifier | Use existing E/M codes for prenatal/antepartum visits with TH modifier if total prenatal encounters prior to 2027 are fewer than four (first 10-week visit on or after Sept 1, 2026) |
Required Provider Billing Actions
Transition billing by first 10‑week visit date; continue current billing for deliveries before Jan 1, 2027
Follow the transitional billing approach tied to the date of the patient’s first 10‑week prenatal visit. Continue current global obstetric billing for any delivery that occurs prior to January 1, 2027. Birthing Options Program providers should follow the same recommended itemized maternity care code transition.
- If first 10‑week visit is on or before May 15, 2026 — continue billing global obstetric codes as currently billed.
- If first 10‑week visit is between May 15, 2026 and July 14, 2026 — bill 59426 (antepartum care only; 7 or more visits) plus delivery‑only code.
- If first 10‑week visit is between July 15, 2026 and August 30, 2026 — bill 59425 (antepartum care only; 4 or 6 more visits) plus delivery‑only code.
- If first 10‑week visit is on or after September 1, 2026 — use existing E/M codes for prenatal/antepartum visits with the TH modifier when total prenatal encounters prior to 2027 are fewer than four.
Operational guidance — consult billing/coding staff and contact HCA with questions
Consult your billing and coding staff to ensure the appropriate codes are used between May 15 and December 31, 2026, based on services actually provided, and contact HCA staff with any questions or concerns about this guidance.
- Review local billing workflows and update operational procedures to reflect the recommended September 1, 2026 transition window to avoid billing errors.
- Engage coding staff to determine when to append the TH modifier to E/M codes and when to use 59425/59426 or legacy global codes.
- If uncertain, reach out to HCA staff for clarification or questions about implementation.
Key Terms and Modifiers
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