South Dakota Medicaid has issued updated obstetrical billing guidance to help providers prepare for American Medical Association (AMA) changes to maternity care coding that take effect January 1, 2027.
Global obstetric codes will remain valid for dates of service through December 31, 2026. However, because some pregnancies will span the transition into 2027, South Dakota Medicaid is allowing providers to begin billing obstetrical services individually before the end of 2026.
For care provided through December 31, 2026, providers may elect to bill:
- Antepartum care: Per encounter using appropriate E/M codes (CPT 99202–99499), pregnancy-related ICD-10-CM diagnosis codes and the TH modifier for routine prenatal care.
- Labor and delivery: Using current delivery-only codes (CPT 59409, 59514, 59612 and 59620). These codes include immediate postpartum care provided on the calendar day of delivery.
- Postpartum care: Per encounter using appropriate E/M codes (CPT 99202–99499), the TH modifier and diagnosis code Z39.2 for routine postpartum follow-up.
Providers may continue using global obstetric package codes through December 31, 2026, when all components of care occur within 2026.
Important for episodes crossing into 2027: If any pregnancy-related care included in a global package extends into 2027, a global maternity package code cannot be used for any portion of that pregnancy episode. Prenatal, delivery and postpartum services must instead be billed individually.
Once a provider begins individual billing for an episode of care, that method must be used consistently throughout the episode. Global and individual billing cannot be combined for the same pregnancy. Providers should also coordinate billing when care is transferred or shared among clinicians to prevent duplicate claims.
South Dakota Medicaid encourages providers to carefully review expected delivery dates and prenatal and postpartum dates of service. Providers may want to consider individual billing for pregnancies that could extend into 2027 to help avoid claim corrections and timely filing issues.
If a billing approach must change because an episode unexpectedly crosses into 2027, previously submitted claims should be corrected within the timely filing period. Global claims that need to be converted to individual billing should be voided and resubmitted using the appropriate individual codes.
View the Obstetrical Services Billing Changes here.
Providers can find additional coverage and billing information in the South Dakota Medicaid Obstetrical Services manual.
