HHS offers temporary enforcement flexibility for maternity episodes crossing into 2027

What changed

In an October 30, 2026 guidance letter, HHS announced temporary HIPAA administrative enforcement discretion concerning the transition to restructured 2027 maternity-care CPT codes. For maternity-care episodes beginning in 2026 and ending in 2027, the letter describes temporary HIPAA enforcement discretion concerning use of 2026 maternity-care CPT codes outside their usual date range during January 1 through December 31, 2027, subject to applicable payer or health-plan business rules and the covered-entity conditions described below. Effective immediately, payers and health plans may issue business rules before January 1 specifying when and how providers, clearinghouses and other trading partners should use those codes for such crossing-year episodes. The letter says those rules should minimize disruption, support accurate payment, align with AMA guidance and be phased out as soon as operationally feasible in 2027.

Beginning January 1, 2027, HHS says it will refrain from HIPAA administrative enforcement against HIPAA covered entities that follow payer and health-plan business rules issued under this discretion. The discretion ends December 31, 2027. It is not a blanket instruction to use old codes for every maternity claim, a guarantee that every payer will accept them, or a waiver of unrelated requirements. The letter expressly says it does not constitute CMS payment policy and references a proposed CY 2027 Physician Fee Schedule change; the final fee-schedule policy and any payer-specific implementation must be checked separately. The letter's recipient-facing flexibility and covered-entity enforcement statement should not be conflated with an independent payment or coverage determination.

Why it matters

Billing, clinical and clearinghouse teams need to distinguish the enforcement statement from a payer’s actual billing instructions and payment policy for an episode spanning the coding transition.

Suggested action

Identify maternity episodes spanning 2026 and 2027; obtain and retain each relevant payer's written transition instructions; configure and test billing and clearinghouse workflows against those instructions; and monitor for payer updates and the phase-out. Confirm the final Medicare Physician Fee Schedule and applicable payer payment rules before submitting or correcting claims, and set a review point before the December 31, 2027 end of discretion.

Sources

• Temporary flexibility regarding 2027 maternity-care CPT codes, U.S. Department of Health and Human Services.