Congress scrutinizes new obstetric CPT codes, flags potential reimbursement gaps

Congress is training fire on the AMA over newly implemented maternity billing CPT codes, citing concerns they may lead to coverage gaps or lower reimbursement. The codes, which went into effect this year, are intended to better capture the complexity of obstetric care but are facing scrutiny from lawmakers who say they were rushed and lack sufficient evidence. The investigation could lead to payer pushback or requests for documentation. OB-GYN practices using the new code set should monitor payer bulletins for any policy shifts and ensure documentation robustly supports the medical necessity and complexity billed under the new framework.