MedicaidBilling CodesHigh impact
Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes
NY Medicaid·NY · OB-GYN, Family Medicine·Claims & Billing
Effective date
Jun 1, 2026
We identified it
May 24, 2026
Summary
Effective for prenatal care starting June 1, 2026, New York Medicaid requires providers to use E/M CPT codes with TH modifier, pregnancy-related O or Z ICD-10 codes for all prenatal visits, and Category II CPT code 0500F for initial prenatal visits. Current billing practices continue for established prenatal care until December 31, 2026.
Action Required
By June 1, 2026: Billing team must update system to append TH modifier to all E/M CPT codes for prenatal visits. Update encounter forms to require pregnancy-related O or Z ICD-10 diagnostic codes for all prenatal visits. Configure system to require Category II CPT code 0500F for initial prenatal visits. Train providers on new coding requirements. For patients with established prenatal care before June 1, 2026, continue current billing practices through December 31, 2026.