The 90-Day Countdown: An OBGYN Practice Audit Checklist for Q4 2026

OBGYN practices have 90 days to rebuild EHR templates, align payer contracts, and train providers before January 1, 2027, when CPT 2027 deletes the global maternity package and every maternity claim moves to phase-based reporting. This OBGYN practice audit checklist breaks those 90 days into monthly tasks with clear owners.

Key Takeaways

• CPT 2027 deletes 17 maternity codes, adds 12, and revises 6 for dates of service from January 1, 2027.
• October is for EHR templates and claim scrubber logic; November is for payers, contracts, and code mapping; December is for provider training and transition safeguards.
• The CMS final rule in early November decides whether Medicare keeps a global option through G-codes.
• Some payers split transition pregnancies by estimated delivery date, not date of service.
• A dedicated CPT 2027 denial category is the fastest way to find and fix failing claim logic.

Why Q4 2026 Is the Real Deadline for Your OBGYN Practice Audit Checklist

Our earlier analysis asked whether your OBGYN billing company is ready for CPT 2027. Three months later, that question has become a calendar, and an OBGYN practice audit checklist is the fastest way to work through it.

The AMA restructuring deletes 17 maternity codes, adds 12, and revises 6, effective January 1, 2027. Consequently, antepartum care, labor management, delivery, and postpartum care each become separately reported phases.

Meanwhile, two moving parts make the fourth quarter decisive. CMS is expected to publish its CY 2027 Physician Fee Schedule final rule in early November, settling whether Medicare keeps a global option through 15 proposed G-codes.

Furthermore, some payers have already moved. New York Medicaid has required E/M billing with modifier TH since June 1, 2026 for patients with an estimated delivery date on or after January 1, 2027.

Three Forces Turning a Code Update Into a Cash Flow Event

Payment timing. Previously, the global model paid one lump sum after delivery. Phase-based billing pays per encounter, so the size and timing of every maternity receivable change at once.

Uneven payer adoption. Medicare, Medicaid, and commercial payers such as UnitedHealthcare, Aetna, Cigna, and Anthem Blue Cross Blue Shield will not move in lockstep. In addition, contracts that price care by 59400 or 59510 have no defined rate for the replacement codes.

Documentation moving to the encounter. A single global note will no longer support payment. Instead, every visit needs its own medical decision-making or time. That shift alone belongs at the top of any OBGYN practice audit checklist.

October 2026: Infrastructure and Documentation

Rebuild antepartum templates. Antepartum-only codes 59425 and 59426 are deleted in 2027, and prenatal care moves to per-encounter E/M reporting. Therefore, templates should capture the setting of each visit and the medical decision-making behind it.

Set postpartum E/M standards. Postpartum code 59430 is also deleted. Postpartum visits are reported per encounter starting the calendar day after delivery, because same-day postpartum care is included in the new delivery codes.

Configure claim scrubber logic. As an early OBGYN practice audit checklist item, load hard stops for all 17 deleted codes on dates of service from January 1, and load coding edits for the 12 new codes before any test claim runs.

November 2026: Payer Alignment and Procedural Mapping

Audit your billing company. As part of your OBGYN practice audit checklist, send a written readiness questionnaire covering the four-phase model, coder training, scrubber updates, and a payer-by-payer adoption log. Otherwise, vague answers in November become denials in January.

Map labor management. New codes 59080 through 59083 report labor management by calendar date and separate straightforward from complex cases. However, the same provider should not report an inpatient E/M service and labor management on the same date.

Integrate the new delivery codes. Delivery is now reported apart from labor management, with new codes for vaginal, VBAC, and cesarean delivery and for procedures such as laceration repair and hysterectomy after cesarean. Before mapping, confirm descriptors against the CPT 2027 Professional Edition.

Verify payer contract valuation. Once the final rule lands, compare how each top payer values the individual phases against what the global fee paid, watching for the underpayments that follow any rate change. Then, request amendments wherever a fee schedule still cites a deleted code.

December 2026: Provider Training and Transition Safeguards

Run provider coding sessions. Specifically, train OBs, certified nurse-midwives, and nurse practitioners to document each encounter on its own, not as part of a global episode.

Deploy a transition protocol. Since payer rules differ, pregnancies that start in 2026 and deliver in 2027 must follow each payer’s rule, which may turn on date of service or on estimated delivery date.

Isolate CPT 2027 denials. A dedicated denial category shows which payer, code, and phase is failing, so denial management can fix root causes within days, not months.

Plan the cash flow bridge. Unlike global fees, per-encounter payments arrive in smaller pieces and on a different schedule. Model the first quarter of 2027 by payer so a slower adjudication cycle does not become a working capital problem. Add that model to your OBGYN practice audit checklist as the final December item.

The 90-Day OBGYN Practice Audit Checklist at a Glance

Each item on this OBGYN practice audit checklist needs an owner and proof of completion. Indeed, a shared intention across coding, contracting, and billing is not a plan.

Month	OBGYN practice audit checklist item	Owner	Evidence of completion
October	Antepartum and postpartum EHR templates rebuilt	Clinical lead	Template change log signed off
October	17 deleted codes blocked, 12 new codes loaded	Billing partner	Scrubber test results
November	Billing company readiness questionnaire	Practice administrator	Written responses on file
November	Labor management and delivery code mapping	Coding lead	Approved crosswalk
November	Payer valuation review after the CMS final rule	CFO	Phase-level rate comparison by payer
December	Provider documentation training	Medical director	Attendance record and chart audit
December	Transition protocol by payer rule	Billing lead	Active pregnancies flagged by date of service or estimated delivery date
December	CPT 2027 denial category live	RCM lead	Reporting view tested

How Readiness Differs by Billing Model

OBGYN practice audit checklist area	Generic billing vendor	In-house team	Specialized OBGYN partner
Claim scrubber updates	Waits for clearinghouse release	Depends on EHR vendor timeline	Deleted and new codes tested before January
Payer adoption tracking	Reacts only when denials arrive	Spreadsheet, if tracked at all	Payer-by-payer log with payer variance detection
Transition pregnancies	Billed by date of service only	Handled case by case	Protocol by payer rule, including estimated delivery date
Denial visibility	Mixed into the general queue	Limited reporting	Dedicated CPT 2027 category with root-cause analysis
CFO reporting	Monthly statement	Manual exports	Phase-level revenue view by payer

In short, the gap between these columns is where Q1 2027 revenue is won or lost. For example, a generalist vendor treating CPT 2027 as a routine code refresh will be fixing claim logic after the denials arrive.

MBC Spotlight: Phase-Based Readiness for Multi-Provider OBGYN Groups

MBC’s OBGYN Center of Excellence brings 25+ years of maternity coding experience to the CPT 2027 transition and to every step of the OBGYN practice audit checklist. Moreover, its Revenue Integrity Framework pairs denial root-cause engineering with payer variance detection, so multi-provider groups see exactly which payer and which phase of care is creating friction.

Additionally, clients work with a dedicated account manager on a system-agnostic platform, backed by a 97% clean claim rate, a 30% A/R reduction within 90 days, and 98% client retention. Learn more about MBC’s OBGYN billing services, or compare vendors in our review of the best OBGYN billing companies.

OBGYN Practice Audit Checklist: Frequently Asked Questions