Addition of the TH Modifier to Support National Maternity Care Coding and Reimbursement Changes Effective September 1, 2026

The American Medical Association (AMA) announced maternity care services code changes that will be effective January 1, 2027. These changes include the removal of 17 billing codes, the addition of 12 billing codes, and revisions to 6 billing codes to reflect modern obstetric practices, allow for more accurate and transparent reporting, and to create a data foundation to better attribute maternal care and support the complexities of team-based care throughout a patient's journey.

In preparation for these changes, MaineCare is also making changes to coding requirements for maternity care services, including the transition to non-global and non-bundled care coding and reimbursement. To ensure consistent reimbursement MaineCare is directing providers to take the following actions no later than prior to September 1, 2026:

  • Adjust maternity care visit billing from global or bundled service codes to Evaluation and Management (E/M) service codes based on each member’s estimated due date and the anticipated number of visits for the remainder of their antepartum period in accordance with AMA Antepartum Transition Reporting guidance;.
  • Append the TH modifier for all maternity care E/M service codes on your claim to identify the visit as a maternity care service;
  • Transition from total-visit tracking to individual encounter documentation, as each prenatal and postpartum visit must now independently support standard E/M complexity or time rules; and
  • Monitor professional guidance from organizations like the American College of Obstetrics and Gynecology and the AMA to prepare billers and systems for the significant coding changes to be effective on January 1, 2027.

As a reminder, providers should also continue to identify and report maternity-related diagnosis codes on all claims submitted to MaineCare, as applicable, to ensure more accurate and transparent data relating to maternity services.   

Please monitor MaineCare e-messages for future updates on this topic.

For questions, please contact your Provider Relations Specialist