CMS proposed G-codes for obstetric billing draw concern from ACOG amid coding transition

The Centers for Medicare & Medicaid Services (CMS) is proposing new HCPCS G-codes for 2027 that would preserve the existing global payment structure for maternity services, drawing concern from the American College of Obstetricians and Gynecologists (ACOG), which warns the move could create a dual billing system that increases administrative burden and worsens obstetric care disparities.^1,2

The proposed G-codes are contained in CMS’s CY 2027 Medicare Physician Fee Schedule (PFS) proposed rule, issued July 14, 2026, and open to public comment.¹ The rule proposes policy changes for Medicare payments under the PFS effective on or after January 1, 2027.

Recently approved obstetric CPT codes developed by the AMA and ACOG, designed as a more granular framework vs a bundled billing approach, are also set to take effect on January 1, 2027, were included in the CMS proposed rule, prompting concerns from ACOG.^1,2

Why were the new obstetric CPT codes developed?

In April 2026, the AMA and the CPT Editorial Panel announced approval of a comprehensive restructuring of maternity care services coding, replacing the legacy global payment model with a framework built around 4 distinct phases of care: antepartum, labor management, delivery, and postpartum.³ The transition followed nearly 2 years of collaborative work between the AMA, ACOG, and multiple national medical specialty societies and was designed to reflect the realities of modern, team-based obstetric practice, including the growing use of telehealth, remote patient monitoring, and individualized prenatal care plans.³

The shift addressed a longstanding limitation of the global model, which bundled all antepartum visits, delivery, and postpartum care into a single payment regardless of clinical complexity. In a previous interview with Contemporary OB/GYN at the 2026 ACOG Annual Clinical & Scientific Meeting in Washington, DC, Eduardo Lara-Torre, MD, FACOG, pediatric gynecologist at the University of North Carolina at Chapel Hill, described why the change matters for high-risk care.⁴

“Some patients require a lot more care, more frequent visits, and a lot more intense care for the visit they’re in because of their high risk. In the past, we got compensated the same way. Didn’t matter how many times they saw us or how difficult their care was. So this is going to be a game changer,” Lara-Torre said.⁴

ACOG President Steven J. Fleischman, MD, MBA, FACOG, echoed this sentiment at the time of the April announcement, calling the unbundling of obstetric codes “long overdue” and stating that the new structure would reduce administrative burden, improve data collection, and enable ob-gyns to provide more tailored, patient-centered care.³

What does ACOG say about the proposed G-codes?

Although ACOG welcomed CMS’s inclusion of the new AMA obstetric CPT codes in the proposed rule and expressed approval of the increased proposed values for new labor and delivery codes, the organization raised direct objections to the proposed G-codes in a statement from ACOG President Camille A. Clare, MD, MPH, CPE, FACOG.²

“ACOG is concerned that CMS is also considering the creation of 15 new HCPCS G-codes for 2027 that would reflect the existing, inadequate global coding and payment structure for maternity services,” Clare said. “CMS’s rationale is that these codes would reduce concerns that adoption of the new obstetric codes from the AMA and ACOG would be disruptive. Yet implementing these G-codes, even for a year, would cause even greater disruption and confusion by increasing administrative burden for obstetric clinicians and practices and forcing them to learn and operate under two separate billing structures.”²

Clare identified a specific clinical consequence of the dual-system approach:

“Specifically, if the G-codes are implemented, patients will be divided into [2] groups: those whose insurers decide to unbundle maternity care and those whose insurers choose not to,” she said. “This presents a real risk of worsening obstetric care disparities when maternal mortality and morbidity remain unacceptably high and creates a barrier to continued progress to improve maternal health outcomes.”²

What are the implications for price transparency and maternal equity?

The new obstetric CPT codes are also designed to improve price transparency, a benefit Clare said could be lost with the use of another bundled approach.

“The G-codes would also undermine efforts to increase price transparency for patients, whereas the new payment structure will allow for a better understanding of pricing and reimbursement for individual obstetric services that is not possible with the bundled system,” she said in the statement.²

The new codes intentionally align with ACOG’s updated approach to prenatal and postpartum care, which allows individualized care plans based on medical, structural, and social determinants of health, a model that would be incompatible with the continuation of a global bundled framework for any portion of the patient population.^2,3

“We urge CMS to adopt the new obstetric codes and make a clean break by not implementing the proposed G-codes,” Clare said. “Otherwise, we will remain stuck in the current system, instead of moving forward toward true value-based maternity care.”²

RELATED: New Obstetric CPT Codes Poised to Transform OB-GYN Reimbursement

References:

1. Centers for Medicare & Medicaid Services. Calendar year (CY) 2027 Medicare Physician Fee Schedule proposed rule. CMS fact sheet. Published July 14, 2026. Accessed July 16, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule
2. Clare CA. ACOG statement on new maternity codes in the 2027 Medicare Physician Fee Schedule proposed rule. American College of Obstetricians and Gynecologists. Published July 2026. Accessed July 16, 2026. https://www.acog.org/news/news-releases/2026/07/new-maternity-codes-in-2027-medicare-physician-fee-schedule-proposed-rule
3. Fitch J. AMA, ACOG announce restructuring of maternity care coding for 2027. Contemporary OB/GYN. Published April 23, 2026. Accessed July 16, 2026. https://www.contemporaryobgyn.net/view/ama-acog-announce-restructuring-of-maternity-care-coding-for-2027
4. Fitch J. Eduardo Lara-Torre, MD, FACOG, on the transition to unbundled obstetric billing for 2027. Contemporary OB/GYN. Published 2026. Accessed July 16, 2026. https://www.contemporaryobgyn.net/view/eduardo-lara-torre-md-facog-on-the-transition-to-unbundled-obstetric-billing-for-2027