January 2027 Maternity Coding Changes:
The Compensation Blind Spot Hospitals Are Missing
As a result of years of collaborative planning among the American College of Obstetricians & Gynecologist (ACOG), the American Medical Association (AMA), and the CPT Editorial Panel, substantial changes are coming to maternity care services reporting.
Effective January 1, 2027, the current global package approach is sunsetting in favor of a service level methodology which seeks to more accurately reflect the care delivered. This overhaul will result in the deletion of seventeen (17) codes, the introduction of twelve (12) new codes, and the revision of six (6) codes.
The CMS Proposed Rule was posted in July 2026, with the AMA and ACOG providing additional commentary. While the Final Rule is anticipated in late fall, compensation teams across the country are already dialing in on revenue cycle and clinical operations readiness.
Physician and clinician compensation can’t be ignored, as these changes touch every aspect of maternity care teams. These considerations range from selecting the best market survey data and preparing benchmarking reports, to administering work RVU calculations, and determining the appropriate language in contracts and compensation plans.
What’s changing
From one code to four phases. Right now, maternity care services are reported using a single global package covering nine months of care. That doesn’t reflect the reality of today’s care models, which involve multiple physicians and clinicians, patients transferring in and out, and the added complexity of high-risk cases.
The new system splits care into four phases:
1. Antepartum care
2. Labor management
3. Delivery
4. Postpartum care
Each phase will have its own menu of codes for reporting maternity services.
Antepartum and postpartum care services will be reported using Evaluation and Management (E/M) codes for each patient visit. E/M coding levels vary based on either total time or the complexity of medical decision making. This shift is central to understanding prospective productivity and compensation.
Small code changes, outsized wRVU impact.
Early modeling from Ludi’s inhouse physician compensation team points to two big takeaways:
First, 8% to 10% of the procedures a physician bills are changing, and those changes account for 40% to 50% of annual work RVU volume.
Secondly, small changes, like the number of antepartum visits, can materially impact wRVU productivity.
Why these coding changes will affect physician compensation
Revenue cycle and payer teams are preparing for this new world. Unless you update your wRVU tables, physician pay may quickly become out of sync. If you rely on outdated formulas, you risk underpaying (and losing talent) or overpaying (and blowing your budget). Neither outcome is just a line-item problem. Both can fracture relationships across your organization.
Ten questions finance and physician compensation leaders should be asking now:
1. How will you calculate wRVUs in 2027?
Most teams don’t use the current-year MPFS for wRVU calculations. With so many new code changes, you’ll need to.
2. Can your current process handle these changes?
Many compensation teams use homegrown tools for assigning wRVUs. Those will need a major overhaul to align with the new code changes.
3. Does contract language need to be revised?
Check every physician contract tied to maternity care. You may need to update terms around wRVU administration or compensation.
4. Who owns physician compensation change management?
If you haven’t assigned a lead, do it now. Your compensation team can’t do this alone. It’s an organization-wide issue.
5. Are you updating compensation formulas before go-live or planning to true up after the fact?
A retroactive fix is tougher to sell than a proactive plan.
6. Do you know how productivity will change for each physician?
If not, you’re behind. Start modeling now to avoid surprises.
7. Is your FMV documentation up to date?
If compliance documentation relies on stale procedural codes and wRVU values, it may need to be updated for current standards.
8. Do you have a plan to reconcile changes in procedural volume?
Go-live isn’t the finish line. This type of change requires monitoring and reporting throughout 2027.
9. Are your physicians in the loop?
Don’t just communicate code changes. Foster engagement around productivity and pay.
10. Who’s the single point of accountability?
You need one person tracking this change across wRVU administration, compliance, and compensation.
CMS’s fee schedule changes on January 1, 2027 regardless of whether your compensation plan is ready for it. The organizations that get ahead of this change will spend the next few months on crosswalks and modeling. The ones that don’t will spend the first quarter of 2027 explaining pay discrepancies to their OB group.
I’d like to hear how other finance and physician compensation teams are staffing this work. If you’re already deep into your 2027 crosswalk, let’s compare notes.
