Payer policy record

Aetna: the 2027 transition

Maternity billing source evidence for Aetna. Verify the product, service, and effective date before applying a policy.

Confirmed 2027 guidance

What the source establishes

Plan scope: Commercial and Medicare members. Texas fully insured plans are subject to the regulatory qualification in the bulletin; confirm the exact product.
Transition: For expected 2027 deliveries, the bulletin describes September–December preventive prenatal billing and a threshold of three versus four visits in 2026.
Global billing: The announced 2027 framework retires global codes. Claims-processing details are still forthcoming.
E/M documentation: Routine and non-routine visits have different modifier and cost-sharing instructions. Do not choose an E/M level from visit number alone.

Aetna · Published 2026-09 · Checked Sep 30, 2026

“This update applies to commercial and Medicare members.”

Sep 30, 2026
Initial source record added
Primary-source research added to the resource center. Clinical review remains pending; this is not a payer policy change.