Why maternal care costs so much in Michigan

Today, MDHHS emailed all Michigan providers. The text is rich in clues to high-cost maternity care.

All Providers,

Effective January 1, 2027, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel is deleting the global maternity care CPT codes representative of antepartum, labor and delivery, and postpartum care services (e.g., 59400, 59510, 59620) and transitioning to the reporting of separate CPT codes for services rendered.

The AMA clarified during a June 2026 webinar that current correct coding guidelines require providers to report global codes for routine maternity care services, in most instances, through December 31, 2026. MDHHS will transition to the reporting of separate CPT codes, including the use of evaluation and management (E/M) codes for routine antepartum and postpartum care, for all dates of service occurring on and after January 1, 2027.

A policy bulletin will be published for public comment in September reflecting coding updates for routine maternity care services furnished on and after January 1, 2027. For routine maternity care services provided on and before December 31, 2026, providers are required to adhere to current Medicaid policy as outlined within the MDHHS Medicaid Provider Manual.

Following the money:

1. The AMA gained monopoly power over CPT Codes used for insurance billing. It has a continuous process to update codes, and publishes new manuals every January. With sole publishing rights, AMA sets rates for its many CPT coding products at will. The AMA Store is cagey about posting prices. However, current AI estimates run to $137 for one manual.
2. Michigan requires Medicaid providers to use CPT Codes.
3. This complicates care immeasurably. Remember that time is money; and in healthcare, time is health; as you dip into Michigan's 2,678-page Medicaid Provider Manual for your light reading fix this weekend.
   https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf
4. MDHHS educates clinicians on using CPT Codes, thereby promoting this AMA product.

Big picture: CPT is only one of the big three coding systems required in US healthcare.

1. US HHS requires Medicaid providers to use the ICD-10. (ICD-11 is a big global goal with 17,000 more codes. It launched in 2022. So far, we in the US are not requiring it.)
2. ICD coding feeds into an individual Risk Adjustment Factor (RAF) Score for everyone in the Medicare and Medicaid (CMS) system.
3. CMS requires HCPCS Level II coding for supplies, medical equipment, injected or IV drugs, and ambulance services. (HCPCS stands for Healthcare Common Procedure Coding System.)

Bottom line: coding is complicated and costly.
Clinicians comply only for reimbursement.
Health insurance and government regulators use codes to access private health information and to control care.