WASHINGTON REPORT
Beginning January 1, 2027, the American Medical Association (AMA) is developing revisions to the Current Procedural Terminology (CPT) coding framework for maternity care.(1) These updates are not routine billing changes. They signal a structural shift in how professional work across the maternity continuum is defined, measured, and attributed. As a result, health systems and physician enterprises should anticipate downstream implications for provider professional services arrangements, including laborist financial support models, employed physician compensation structures, and professional services agreements (PSAs). While clinical coverage requirements and staffing expectations will remain unchanged, increased measurability of inpatient obstetric professional services will place greater emphasis on attribution methodology, compensation alignment, and governance oversight.
The Coding Shift: What Changes and What Does Not
Today, maternity care is commonly billed using global obstetric codes that bundle routine antepartum care, delivery, and postpartum services into a single professional payment. While administratively efficient, this framework often obscures those who perform inpatient services, particularly in hospital- or team-based delivery models.
Starting in 2027, the CPT coding set is expected to move away from global obstetric constructs toward discrete recognition of professional services across the maternity continuum. These revisions are being developed through the AMA CPT Editorial Panel(2) and related workgroups. Final code definitions and relative value unit (RVU) assignments are expected in the 2027 CPT publication, with Medicare and Medicaid coverage policies to follow. Commercial payer adoption will depend on individual payer coverage determinations and contract cycles, and organizations should not assume uniform adoption at the time of Medicare and Medicaid implementation. Documentation and workflow discipline will therefore play a greater role in how work is measured and attributed.
What does not change is the underlying need for continuous labor and delivery coverage. The shift affects attribution and visibility, not workload.
How Delivery Episodes Are Billed and Attributed: Current and Future Landscapes
Table 1 illustrates how inpatient obstetric services are commonly billed and attributed under the current global framework (effective through 2026), and how attribution is expected to change beginning on January 1, 2027, under a more discrete maternity coding structure. These expectations reflect directionally anticipated changes and may evolve based on final code and policy releases. While final CPT definitions and payer policy may vary, the direction of change is toward discrete attribution of inpatient professional services.
The Coverage Model Landscape
Health systems typically meet labor and delivery coverage needs through three broad models: hospital-supported laborist programs, employed OB/GYN group models, and PSAs with system-aligned individual physicians and/or physician groups. Each model responds differently as delivery-related services become more discretely measured and attributed.
Laborist Financial Support Agreements
Laborist programs are designed to provide continuous, on-site labor and delivery coverage, including emergency department and unassigned OB/GYN services. These programs typically negate the need for private practice physicians to take on-call coverage by securing continuous on-site coverage. Baseline costs borne by these practices do not scale directly with underlying patient activity. Given their on-site presence, laborist practices often provide portions of intrapartum management and delivery services for patients of community physician or outpatient practice groups.
Under the current global obstetric billing framework, laborist practices may not be able to bill and collect for delivery-only or cesarean-only CPT codes because of payer policy and/or state regulation. In response, markets have developed obstetrical service agreements between laborist groups and community physicians to compensate laborists for work performed during the global period, structured to comply with the federal Anti-Kickback Statute (42 U.S.C. § 1320a–7b(b)). These arrangements are typically limited in scope and do not fully offset the cost of continuous coverage, and hospital financial support remains a common and necessary component of laborist program economics.
As maternity coding becomes more discrete, measurable professional activity attributable to laborists may increase, leading to less required financial support provided by hospitals and health systems. Stark Law (42 U.S.C. § 1395nn) considerations may arise if fixed payment terms are not adjusted in response to increased collections, particularly in cases where laborist costs do not materially change. However, true availability obligations remain, and financial support arrangements are likely to evolve rather than be eliminated.
Employment Models
Employment models for OB/GYN services range from productivity-weighted to salary-dominant designs, often with call compensation layered in. As inpatient services become more discretely measurable, productivity attribution may shift without corresponding changes in staffing burden. To the extent midlevel providers are leveraged during delivery episodes, attribution of wRVUs may also shift from physicians to midlevel providers.
Internal equity, pooled productivity methodologies, and coordination of call compensation become more important as attribution becomes clearer. Under current billing constructs, many integrated delivery systems have adopted pooled productivity models to distribute compensation equitably across providers working in inpatient maternity care, particularly when attribution was unclear or unavailable. With the expected shift toward discrete attribution for triage, intrapartum, delivery, and postpartum care, organizations may gain the ability to assign RVU credit based on actual service provision rather than defaulting to a shared or blended pool.
As a result, some systems may reconsider the need for pooled productivity approaches in obstetrics, especially where consistent documentation and role delineation support direct attribution. However, pooled models may remain appropriate in group-based staffing environments or where patient hand-offs are frequent. Organizational philosophy, team dynamics, and operational feasibility will continue to shape whether attribution transparency leads to unpooled models or more refined pooling mechanisms. Governance processes and reset cadence will ultimately determine how effectively compensation models adapt.
Professional Services Agreements
PSAs vary widely in scope and economic structure. Call coverage arrangements, for example, may be fully restricted (i.e., on-site), fully unrestricted (i.e., remote), or a hybrid of both. Compensation structures take into consideration professional billing and collecting assignment. When physicians and physician groups hold billing and collection rights, per diem compensation rates, professional collections and sometimes payment for care rendered to indigent patients constitute the compensation structure. When the hospital retains professional billing rights, per diem payments plus hourly activation rates or compensation per wRVU for call-back time are common. Independent valuation experts directly consider the attribution of work and other remuneration when establishing FMV compensation amounts, and the forthcoming billing changes will impact these calculations. As attribution becomes more transparent, PSA structures will need to be evaluated against updated productivity data and FMV benchmarks to ensure continued alignment between compensation design and documented scope of services.
Broader Care Team Considerations
Labor and delivery care is inherently team-based. Certified nurse midwives, advanced practice providers, and family medicine physicians frequently contribute to delivery episodes under collaborative care models, including pooled or shared compensation arrangements for applicable specialties. As delivery services become more discretely attributed, organizations may need to reassess productivity allocation, call responsibilities, and role delineation across care teams.
Clearer attribution of delivery services may also influence service line planning for downstream specialties, including pediatrics and neonatology, particularly in integrated women’s and children’s programs.
Preparing for Quantification
Final CPT code definitions, RVU assignments, and reimbursement guidance will be released by AMA and CMS closer to the implementation date. Until that guidance is available, precise economic modeling is appropriately deferred. Organizations can prepare by establishing documentation standards, defining attribution rules, and reviewing compensation governance structures so they are positioned to act once final guidance is issued. Organizations should also evaluate whether current compensation governance structures allow for timely resets once attribution patterns shift.
Key Takeaway
The 2027 maternity billing changes will not eliminate the operational cost of labor and delivery coverage, but they will materially change how professional work is measured and attributed. Laborist financial support arrangements, employment compensation plans, and PSA structures will each be affected differently. Organizations that proactively assess coverage economics, compensation design, and governance will be best positioned to navigate this transition.
Disclaimers: This article was last edited as of April 3, 2026. Subsequent regulatory guidance, CPT code definitions, or payer policy releases may affect the analysis presented herein.
The CPT coding revisions referenced in this article are being developed through the AMA CPT Editorial Panel process. The American College of Obstetricians and Gynecologists (ACOG) provides relevant guidance on obstetric payment policy and is cited here for context. Organizations should monitor AMA CPT Editorial Panel communications and the 2027 CPT publication directly for final code definitions and RVU assignments.
References
American College of Obstetricians and Gynecologists. Payment for obstetric services. Accessed February 12, 2026. https://www.acog.org/practice-management/coding/coding-library/payment-for-obstetric-services
American Medical Association. CPT code process. Accessed February 12, 2026. https://www.ama-assn.org/about/cpt-editorial-panel/cpt-code-process