Maternity Unbundling: Eleven Weeks to Go

On January 1, more than thirty years of bundled maternity billing ends and care moves to separately reported phases. That much is settled.What is not settled is how it will be paid for.

Building on the WHIS explainer webinar earlier this year, this session focuses on CMS' proposed changes now the comment window has closed. CMS has proposed either adopting the new CPT code set or creating parallel G-codes that preserve the existing global structure. The final rule is not expected until November, and no payer outside Medicare is obliged to follow either path. Commercial payers and state Medicaid programs are setting their own timing independently. The industry is building for two scenarios at once, with eleven weeks to go.

Maternity is the largest category of spend in women's health, so this reaches well beyond billing. It changes what employers are exposed to, what digital health companies can contract for, and what women pay at each prenatal visit.

This session is designed to give attendees insight into:

· Where cost and revenue actually move under per-encounter reporting: cash timing, claim volume, documentation load, and provider compensation models built on global maternity assumptions

· How health plans are approaching contract repricing, claims configuration and coding intensity controls, and whether prenatal visits are treated as preventive or subject to member cost sharing

· What self-insured employers and their advisors should be asking carriers and TPAs now, and how to model maternity exposure while the payment structure is unresolved

· What newly separable codes mean for digital health and virtual maternity companies, where per-encounter visibility creates both new reimbursement pathways and contract risk

· Where risk concentrates if a dual coding environment persists, particularly for Medicaid-heavy, rural and safety-net providers, and what that means for access