Important Update – Upcoming NYSDOH changes to Global Obstetric Codes for Prenatal Services
IMPACTED LOB’s: Medicaid, HARP, CHP
TO: Obstetricians
Dear MetroPlusHealth Provider,
Effective January 1, 2027, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) will replace global obstetric (OB) codes with itemized, visit-level billing. This change is intended to ensure that providers are appropriately reimbursed for services delivered during antepartum and postpartum care.
Beginning June 1, 2026, providers must bill routine prenatal care using evaluation and management (E/M) codes with the TH modifier for members with estimated delivery dates on or after January 1, 2027. For delivery dates prior to January 1, 2027, providers must continue to use the existing global OB codes. MetroPlusHealth is ready for you to submit bills to us using the E/M codes with TH modifier and we are fully prepared to provide continuous support to our providers throughout the implementation of these changes.
| CPT Code | CPT Description |
|---|---|
| 99202 | Office or Other Outpatient Visit for New Patient |
| 99203 | Office or Other Outpatient Visit for New Patient |
| 99204 | Office or Other Outpatient Visit for New Patient |
| 99205 | Office or Other Outpatient Visit for New Patient |
| 99211 | Office or Other Outpatient Visit for Established Patient |
| 99212 | Office or Other Outpatient Visit for Established Patient |
| 99213 | Office or Other Outpatient Visit for Established Patient |
| 99214 | Office or Other Outpatient Visit for Established Patient |
| 99215 | Office or Other Outpatient Visit for Established Patient |
| 99341 | Residence Visit for New Patient with Straightforward Medical Decision Making |
| 99342 | Residence Visit for New Patient with Low Level Medical Decision Making |
| 99344 | Residence Visit for New Patient with Moderate Level Medical Decision Making |
| 99345 | Residence Visit for New Patient with High Level Medical Decision Making |
| 99347 | Residence Visit for Established Patient with Straightforward Medical Decision Making |
| 99348 | Residence Visit for Established Patient with Low Level Medical Decision Making |
| 99349 | Residence Visit for Established Patient with Moderate Level Medical Decision Making |
| 99350 | Residence Visit for Established Patient with High Level Medical Decision Making |
| 99417 | Prolonged Outpatient Service, Each 15 Minutes |
| CPT Code | CPT Description |
|---|---|
| 59400 | Vaginal delivery with antepartum and postpartum care |
| 59425 | Antepartum care only; four to six visits |
| 59426 | Antepartum care only; seven or more visits |
| 59510 | Cesarean delivery with antepartum and postpartum care |
| 59610 | Vaginal birth after cesarean delivery with antepartum and postpartum care |
| 59618 | Cesarean delivery after attempted vaginal delivery with antepartum and postpartum care |
If you have any questions or require additional clarification, please contact Provider Relations Operations at [email protected]