Unbundling CPT Codes for Birth Centers: What You Need to Know Now

If you run a freestanding birth center, you’re already juggling licensure, accreditation, staffing, Medicaid contracts and the daily realities of on-call life. Now you’re also trying to manage the unbundling CPT codes for birth centers, and it can sound like one more change on an already long list. In reality, it’s a practical shift that will change how you bill for the care you’re already providing.

For years, most maternity care has been paid through a single global case rate: one bundled payment covering prenatal care, delivery, and postpartum. You send a big claim near the end of care, track that one payment, and try to reconcile any transfers or complications after the fact. With unbundling CPT codes for birth centers, that global “all-in-one” approach goes away. In its place, you’ll be billing for each prenatal visit, each postpartum visit, and each phase of intrapartum care using E/M codes and new maternity-specific CPT codes.

This is about making sure directors and owners understand the basic shape of the change so you can lead your teams through it, ask sharp questions of payers and vendors and avoid a surprise cash flow crisis when 2027 arrives.

What Unbundling CPT Codes Means for Birth Centers

Under the old global model, most of the financial work happened once: you billed a single global code, watched for that one payment and dealt with the exceptions later. With unbundling CPT codes for birth centers, the work is more granular and more frequent.

Here’s how that shows up in real life:

• Each prenatal visit, postpartum visit, and qualifying service is documented and billed on its own, using E/M codes and new maternity CPT codes.

• Claims go out on an ongoing basis instead of a single submission after delivery.

• Charting has to clearly support the level of service billed at that encounter, whether you choose the code by time or by medical decision-making.

Billing becomes a continuous part of the care cycle, not a one-time event at the end. That can feel like more administrative work, especially for small teams. But it also creates a pathway to steadier, more predictable revenue throughout pregnancy instead of waiting months to be paid.

Intrapartum Care: A Pressure Point for Community Midwives

One place where birth centers and community midwives need to look closely at the new codes is the intrapartum phase or labor management. Under the proposed structure, labor management is reported with daily codes that reflect whether care is straightforward or complex. Those codes and their relative value units were built on assumptions drawn primarily from hospital-based practice patterns, not from the length and intensity of continuous labor support in community settings.

For example, committee recommendations assume roughly 80 minutes of intrapartum professional time per day, while community midwives routinely spend 6–10 hours or more at the bedside managing labor, monitoring progress, supporting physiologic birth and coordinating risk decisions. That gap between assumed time and actual labor support means that, without intentional advocacy, midwives providing home and birth center care could be underpaid for some of the most intensive work they do. For birth centers, intrapartum care is therefore a key area to scrutinize contracts, push for higher reimbursement tied to the true duration and complexity of labor management and remind payers that the current assumptions were built for hospital workflows, not for community-led support.

Interview with a Biller

To move out of theory and into the day-to-day reality of billing, I wanted readers to hear directly from a biller who works with midwives and birth centers every day. Below is a conversation with Best Way Medical Billing about how unbundling CPT codes will show up in your day-to-day operations, what to prioritize and how to turn this transition into an advantage rather than a crisis.

To help you think through what this means on the ground, I sat down with Best Way Medical Billing to talk about what birth centers should be doing today to get ready, where the biggest risks and opportunities are and how leaders can begin, even if they feel behind.

Below is our full conversation:

1. What are the biggest risks you see for birth centers if they don’t prepare now?

The practices that wait until the last minute will likely face delayed payments, denied claims and unnecessary financial stress. Some of the biggest concerns include: Outdated fee schedules that don’t reflect the new coding structure. Insurance contracts that have not been reviewed or updated. EMRs that are not configured to generate accurate superbills or visit-level claims. Clearinghouse edits that reject claims because coding workflows were never tested. Documentation that doesn’t support the billed Evaluation and Management (E/M) level. Timely filing issues if visits are not billed promptly. Because reimbursement will depend on multiple claims throughout pregnancy, even small workflow problems can snowball into large accounts receivable balances. Preparing early gives practices time to test systems before the changes become mandatory.

3. What is one small project a birth center can start this month to get ready?

Start by mapping your entire patient journey from the first prenatal visit through postpartum discharge. Document exactly who performs each task, when documentation is completed, when coding occurs, when claims are submitted and how payments are posted. Most practices discover workflow gaps they never realized existed. Fixing those now is far easier than trying to solve them after reimbursement changes take effect. This exercise also identifies where automation, staff training or software improvements can make the biggest difference.

4. Where do you see opportunities for birth centers in this new model, not just risks?

Although many people are focused on the challenges, I actually see significant opportunities. Birth centers that prepare well can improve cash flow by receiving reimbursement throughout pregnancy rather than waiting until care is complete. The new structure also allows practices to better demonstrate the value of the care they provide. Midwives spend substantial time educating patients, coordinating care, managing risk and providing individualized support. Proper documentation allows that work to be more accurately reflected in reimbursement. Practices that build efficient billing systems now will also be positioned for stronger financial stability and easier growth in the future.

5. What should birth center leaders be asking their billers and software vendors right now?

Ask very direct questions. Is our software fully prepared for visit-level billing? Will it generate accurate superbills under the new CPT structure? How will E/M coding be supported? Can fee schedules be updated easily? Will our clearinghouse require any workflow changes? Have our insurance contracts been reviewed for the new reimbursement model? What staff training will be necessary before implementation? Have we tested the entire billing process from documentation through payment? If your vendor or billing company cannot clearly answer these questions today, now is the time to start those conversations.

6. If a director is reading this and feeling behind, what would you tell her?

First, don’t panic. Many birth centers are still trying to understand exactly what these changes mean. You’re not alone. The important thing is to start now rather than waiting until implementation is around the corner. Begin with education, review your workflows, involve your billing team early and identify any technology gaps. Small improvements made consistently over the next several months will have a much greater impact than trying to overhaul everything at the last minute. This transition isn’t simply about complying with new CPT codes. It’s an opportunity to strengthen your financial foundation, improve operational efficiency and build a more sustainable birth center for the future. With planning, training and the right support team, this change can become a competitive advantage rather than a crisis. For readers who would like to connect with us or learn more about our services, they can reach us at: Best Way Medical Billing 🌐 Website: www.bestwaymedicalbilling.com 📧 Email: billing@bestwaymedicalbilling.com 📞 Phone: (888) 297-3982

Further Reading

• New OB Codes Transition Plan for Ob-Gyns: Toolkit 2026 (ACOG) – Overview of the national transition timeline, coding strategy, payer conversations and operational considerations leading up to 2027 implementation.

• AMA – CPT 2027 Maternity Care Services Code Changes – Central AMA hub outlining the new maternity care CPT structure, with links to the maternity care services codes and guidelines PDF, education briefs, FAQs and webinar recordings previewing the 2027 restructure.

• AABC The Great Unbundling Roadmap – Birth center-focused guidance for mapping workflows, preparing documentation and systems, testing claims and understanding the broader operational impact of unbundling maternity CPT codes.