New CPT Codes Address Maternity Care, AI – But Payment Questions Remain
By Alisa Pierce

The American Medical Association has released its 2027 CPT code set, with updates that reflect team-based obstetric care and the use of artificial intelligence (AI) for certain services or procedures, among other updates – but if insurers do not incorporate changes into their payment structures, physicians who use the new codes may be stuck without payment.

The code set, which goes into effect Jan. 1, 2027, adds 10 new AI-related codes, bringing the total number of AI CPT codes to 43. It also includes significant changes to maternity care that will allow physicians to bill for certain services individually rather than under the longstanding global maternity-care bundle.

Texas Medical Association Board of Trustees member Ezequiel “Zeke” Silva III, MD, says the goal of AMA’s coding changes is to more accurately represent the work physicians provide. Dr. Silva chairs AMA’s Relative Value Scale Update Committee, which plays a key role in the valuation of CPT services.

He said the changes to maternity coding, for example, create a more “granular” billing approach that better suits contemporary obstetrics.

“The old maternity care model where one physician managed one patient throughout their entire pregnancy journey is just no longer common,” the San Antonio interventional radiologist said. “Now, it’s more likely that a team of physicians will manage that patient’s care, which is a reality the new code set is trying to capture.”

However, the practical impact of the 2027 changes will depend on whether and how commercial health plans and the Centers for Medicare & Medicaid Services (CMS) ultimately use and value those codes. Payers must still decide whether and when to incorporate the CPT changes into their payment systems – and CMS has yet to hold rate hearings to determine its own related payment structure, says Carra Benson, director of TMA’s Physician Payment Resource Center (PPRC).

As a result, physicians may face payment delays and even denials if they use the new code set without first verifying that the relevant payer adopted it, Dr. Silva says.   

“Just because AMA [releases] codes … doesn’t mean automatically all health plans will pay. It can take a long time before new codes are accepted and paid for,” he told Texas Medicine Today.

Additionally, Dr. Silva says many of the new AI-related CPT codes fall under Category III, which are a set of temporary codes that allow data collection for emerging technologies, services, or procedures and are intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.

The 2027 CPT set also updates codes representing radiology, sleep medicine, and several other areas, including:

• New and revised guidelines, including three new codes involving left ventricular assist devices;
• Nine new codes that expand reporting options for traumatic and non-traumatic open, laparoscopic, and thoracoscopic diaphragmatic hernia repair procedures;
• Updated codes and guidelines that better reflect current prostate biopsy techniques and improve data specificity; and
• A new time-based code structure to align reporting with how biofeedback training is commonly delivered.

TMA’s PPRC is monitoring how and when health plans will pay for the new codes. Ms. Benson says physicians should continue to monitor billing correspondence from payers and reach out to TMA with questions or concerns. Dr. Silva also suggests practices could prepare their internal claims software for when new related health care policies take effect.

Coding resources, including print and digital versions of the CPT codebook, data file products, and CPT educational content, are available through AMA.

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