Which Prenatal Code You Bill Now Depends on the Card

If you bill obstetrics, the September 1 line has already split your schedule, and it split differently depending on whose card the patient handed you.

Cigna posted its September policy update on Tuesday the 15th, a 36-page PDF stamped "Effective September 15, 2026 (unless otherwise noted)." Two reimbursement policies carry a new block of text the August, July and June editions do not contain anywhere: Multiple Births (R03) and Global Maternity/Obstetric Package (R11), both marked Updated, both now carrying what Cigna calls a Maternity Banner.

The operative sentence, bolded and italicized in Cigna's own document:

"Therefore, Cigna Healthcare is not changing its current maternity billing guidance at this time."

Three weeks earlier, Aetna's September OfficeLink told its network the opposite.

Three Payers Read the Same Date

Every document in this story keys off September 1, 2026. They disagree about what happens on it.

Aetna, page 8 of the September OfficeLink Updates, applying to commercial and Medicare members: "For patients expected to deliver in 2027, preventive prenatal visits on or after September 1, 2026 should be billed with the applicable E/M code, modifier TH and pregnancy diagnosis code(s) when three or fewer visits are provided before January 1, 2027. Once four prenatal visits have occurred in 2026, billing should follow the current antepartum coding guidelines."

MassHealth, All Provider Bulletin 419, issued in August and signed by the Assistant Secretary: for patients whose first prenatal visit following confirmation of pregnancy occurred on or after September 1, 2026, providers "may report services using the appropriate evaluation and management (E/M) code with modifier TH to indicate the visit is related to prenatal care." The bulletin lists the full sets, office and inpatient and telemedicine, all with TH appended.

Cigna, in the Provider Newsroom article the banner points to, dated August 24 and updated September 14: "For patients whose initial prenatal visits occur on or after September 1, 2026, in order to avoid payment delays or unnecessary claims reprocessing: Do not submit the American College of Obstetricians & Gynecologists (ACOG) proposed and AMA-recommended prenatal care Evaluation and Management (E/M) CPT codes."

And UnitedHealthcare has said nothing at all. We pulled both public channels this run. The live commercial Obstetrical Policy, number 2026R0064A, contains the string "2027" exactly zero times and still instructs the network that "the Current Procedural Terminology (CPT) book identifies the global OB codes as: 59400, 59510, 59610 and 59618." The September Medical Policy Update Bulletin contains no occurrence of maternity, obstetric, antepartum, global or 2027.

So two of the four say switch to E/M plus TH, one says do not, and one has not spoken. Worse, the two that agree on the instruction disagree on the trigger: Aetna keys off the expected delivery year and a four-visit count, MassHealth off the date of the first prenatal visit. The same patient can be a switch patient under one contract and a do-not-switch patient under another, on facts your intake staff captures in different fields.