By Janet Choi, MD, Chief Medical Officer, Progyny
As an REI, OBGYN, and now a Chief Medical Officer, I have had the privilege to be part of thousands of paths to parenthood – both directly and indirectly. Stating the obvious, no two maternal journeys are the same. Yet for decades, bundled maternity payments operated under the assumption that pregnancy follows a standard path.
Recently, maternity CPT codes, which are used by health insurance companies, Medicare, and Medicaid to process claims, determine reimbursement, and more, were updated from one bundled payment to separate, itemized claims for every service. Although this change will inevitably evoke questions, this update is an overdue modernization of the coding system. Updating the codes used to document and bill for specificity will better reflect how care is delivered today: increasingly individualized, multidisciplinary, and supported by technology enabled care models.
Every pregnancy is different. Some are uncomplicated. Others may begin without major complications but then evolve into pregnancies with complex care needs whether from underlying or newly diagnosed medical conditions – diabetes, hypertension, depression/anxiety. And then there is postpartum – often a time when care of the birthing parent falls to the wayside – and a time when many women may fall through the cracks – a time when medical issues such as hypertension, preeclampsia, depression /anxiety/psychosis can occur. Modern maternity care is no longer defined by a fixed schedule of routine office visits with a single clinician; instead, it is personalized, multidisciplinary, and responsive, bringing together a care team across obstetric and specialty care, behavioral health, lactation, and pelvic floor support. This care can also require navigation across in-person visits, virtual care, and remote monitoring as clinical needs, circumstances, and preferences change. For employers and health plans, supporting maternal health means ensuring that the parents can access coordinated, individualized support as their needs evolve.
These upcoming coding changes around pregnancy and postpartum care raise questions and provide uncertainty among payors and employers, as well as patients and providers. The transition may also bring operational complexity, including more detailed claims, new reporting challenges, and the need for clear member communication.
But the positive side of change — is that it is an opportunity for progress.
So rather than viewing unbundling as a disruption, health plans are presented with the opportunity to see it as a chance to better align payment with individualized, high-quality care.
Why now is the time for maternity coding to catch up
Bundled payments were designed to simplify reimbursement by treating prenatal care, delivery, and postpartum care as a single episode of care.
While that approach reduced administrative complexity, it also assumed that every pregnancy required essentially the same services. Which couldn’t be further from reality.
Some patients need extensive care coordination, behavioral health support, nutrition counseling, or specialist consultations. Others experience uncomplicated pregnancies with relatively few interventions. A reimbursement model built around averages doesn’t reflect those differences.
Timing is important. In 2025, ACOG released guidance on Tailored Prenatal Care, emphasizing a more individualized approach based on medical risk, unmet social needs, patient preferences, and appropriate care modalities. The 2027 maternity CPT updates fit within that broader shift: a coding modernization that better reflects today’s maternity care and supports improved visibility and quality measurement. Unbundling creates an opportunity to better match care with individual patient needs rather than a standardized payment model.
The goal shouldn’t simply be itemizing reimbursements differently. It should be enabling better care.
Five questions every payer should ask when evaluating maternity reimbursement models:
1. Does payment unbundling support personalized maternity care – or standardized care?
While ensuring that providers are justly reimbursed for their skills and efforts, the true focus on examining the effectiveness of these coding changes is whether they translate to supporting the right care for each patient. Health plans should evaluate whether reimbursement allows providers to tailor care based on clinical risk factors, social determinants of health, and patient preferences rather than fitting every pregnancy into the same framework.
2. Will this improve access to multidisciplinary care?
Especially with the evolution and acceptance of virtual care models and the potential opportunities offered by remote patient monitoring devices, pregnancy care these days is more than a series of routine in-office prenatal visits.
Rather, many patients benefit from a variety of in-person as well as virtual services–behavioral health, nutrition support, doula, lactation counseling, maternal-fetal medicine, genetic counseling, as well as benefit and care navigation.
As reimbursement evolves, health plans should ask whether the new model makes it easier – not harder – for patients to access the broader care team they need.
3. How will success be measured?
Coding modernization only matters if it supports quality measurement and care improves. Health plans should define success by meaningful outcomes: healthier pregnancies, fewer maternal and fetal/infant complications, better patient experiences, narrower equity gaps, and a clearer understanding of cost drivers.
The goal isn’t a new way to pay for care – it’s a better way to deliver it.
4. Does this create flexibility for changing patient needs?
Pregnancy rarely follows a linear path.
A patient who seems to begin as low risk may develop complications later in pregnancy. Another may need additional postpartum support after delivery.
Payment models should allow providers to respond to changing clinical needs without unnecessary administrative barriers. Flexibility is a hallmark of patient-centered care.
5. How will patients experience this change?
Patients shouldn’t have to understand reimbursement models to receive excellent care.
Health plans should consider whether any operational changes remain largely invisible to patients while supporting smoother coordination, clearer communication, and more personalized care throughout pregnancy and postpartum.
Ultimately, success will be measured by whether families feel supported – not by how claims are processed.
Looking ahead
Healthcare continues moving toward more individualized care, and maternity care should be no exception. Health plans who stay cognizant of these evolutions, ask the right questions, and remain receptive to change will be uniquely positioned to support more personalized, coordinated maternity care while improving outcomes for members and their families.
No two pregnancies are identical. Payment models shouldn’t assume they are.
Unbundling represents more than an administrative change – it offers an opportunity to better align reimbursement with the realities of modern maternity care. When thoughtfully implemented, it can support more personalized care, strengthen care coordination, and create greater flexibility to meet patients where they are.
This is also where providers like Progyny complement provider care, through early engagement, proactive navigation, behavioral health screening, education, and postpartum support. More detailed coding can improve visibility, but visibility alone does not improve outcomes. Families need support before, during, and after pregnancy, especially as their needs change.
For payers, the opportunity isn’t simply adapting to a new reimbursement model, it’s helping build a maternity care system that recognizes what clinicians and patients have always known: the best pregnancy care starts with treating every individual as exactly that – an individual. And that is best accomplished with a partner who can help translate greater visibility into better care. By helping payers anticipate evolving needs and coordinate care around the individual, Progyny can help turn coding modernization into meaningful progress for members and their families.