Tailored Prenatal Care: How ACOG’s New Visit Model Reshapes 2026 Practice
Tailored prenatal care replaces the 12-to-14-visit one-size-fits-all model with risk-based schedules and telehealth options. ACOG and major OB/GYN societies have endorsed the shift, and CPT billing codes change in 2027.
Why Tailored Prenatal Care Is in the News Right Now
Tailored prenatal care has moved from concept to active implementation in OB/GYN practices nationwide following ACOG Clinical Consensus 8: Tailored Prenatal Care Delivery for Pregnant Individuals, which replaces the traditional 12-to-14-visit, in-person prenatal schedule with a flexible, risk-based, telehealth-friendly model.
The consensus, originally released in April 2025 and endorsed by the American College of Nurse-Midwives, the Society for Maternal-Fetal Medicine, and four other organizations, now intersects with two billing milestones: ACOG-recommended use of evaluation and management (E/M) codes for antepartum care by September 1, 2026, and the deletion of global obstetric CPT codes effective January 1, 2027.
Practices that began transitioning visit cadence and modality during the COVID-19 era are now operationalizing the model formally — including routine social-needs screening before 10 weeks of gestation and shared decision-making about how often, and how, patients are seen.
The Background Behind Tailored Prenatal Care
The standard “4-2-1” schedule — visits every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly through delivery — was first formalized in 1930 and has remained largely unchanged for almost a century.
Despite this longevity, the United States has the highest maternal mortality rate among high-income countries: 22 deaths per 100,000 live births in 2022, according to the Commonwealth Fund. The COVID-19 pandemic forced rapid uptake of telemedicine and revealed that many low-risk pregnancies could be safely managed with fewer in-person visits.
ACOG and the University of Michigan convened the PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) panel, which used the RAND/UCLA Appropriateness Method to develop the consensus recommendations.
The Evidence So Far
The clinical consensus is grounded in three lines of evidence:
- Visit cadence: Three systematic reviews showed that average-risk patients on targeted (6–10 visit) schedules had similar maternal and neonatal outcomes to those on the traditional schedule
- Telemedicine: A 2023 systematic review of two randomized trials, four nonrandomized comparative studies, and one survey found patients with a hybrid telehealth and in-person schedule had similar outcomes and reported a better maternal experience
- Group care: Group prenatal care reduced social isolation and improved health literacy in select populations, particularly when offered in patients’ preferred language
ACOG’s authors emphasize that the quality of evidence is generally low, study sizes were heterogeneous (1 to 6 telemedicine visits across studies), and most trials were underpowered for rare adverse outcomes such as stillbirth or severe maternal morbidity.
Where Experts Disagree
Endorsement among professional societies is broad, but practical concerns remain. Christopher Zahn, MD, FACOG, ACOG’s chief of clinical practice, framed the shift in stark terms:
“We have been doing the same one-size-fits-all for nearly 100 years” — Christopher Zahn, MD, FACOG, ACOG Chief of Clinical Practice
The Policy Center for Maternal Mental Health endorsed the model but urged ACOG to address postpartum visit frequency more directly and pushed CMS and state Medicaid programs to update payment protocols. Some rural and safety-net practices have noted that the model is not turn-key — patients without reliable broadband, home blood-pressure cuffs, or work flexibility may not benefit equally. ACOG’s authors themselves acknowledge that maternity care deserts and under-resourced practices may struggle with the social-needs screening and remote-monitoring components.
The Practical Question for OB/GYNs
Tailored care does not mean less care. ACOG explicitly states that patient assessments and visit planning often require more time per encounter, even when the total visit count drops. Health systems are encouraged to lengthen individual visit slots so that overall time with each patient is preserved.
A practical implementation checklist:
- Comprehensive needs assessment: Conduct medical, social, and structural drivers-of-health screening ideally before 10 weeks of gestation
- Risk stratification: Classify each patient as average-risk or greater-than-average-risk; the average-risk definition includes patients with stable chronic hypertension or gestational diabetes
- Shared decision-making: Set visit cadence and modality (in-person, telemedicine, or group care) jointly with the patient
- Dynamic plan: Adjust the schedule as pregnancy progresses based on clinical and social changes
- Billing transition: Begin using E/M codes (CPT 99202–99499) for antepartum care by September 1, 2026, ahead of full code restructure on January 1, 2027
- Visit length: Increase individual visit duration so cumulative clinician time per pregnancy is at least equal to traditional care
What to Watch For
- Tailored prenatal care implementation tools and resources at acog.org/TailoredPrenatalCare
- The transition to the new maternity-care CPT code set effective January 1, 2027
- Expected updates to ACOG’s 2018 “Optimizing Postpartum Care” Committee Opinion
- CMS and state Medicaid policy changes supporting unbundled payments for telemedicine and home monitoring
- Outcomes data from health systems implementing the model in maternity care deserts and rural areas
Sources
- American College of Obstetricians and Gynecologists. Tailored Prenatal Care Delivery for Pregnant Individuals: ACOG Clinical Consensus No. 8. Obstet Gynecol. 2025 May;145(5):565–577. doi:10.1097/AOG.0000000000005889. ACOG Clinical Consensus 8: Tailored Prenatal Care Delivery
- American College of Obstetricians and Gynecologists. New ACOG Guidance Recommends Transformation to U.S. Prenatal Care Delivery. Press release, April 17, 2025. ACOG Press Release on Tailored Prenatal Care
- American College of Obstetricians and Gynecologists. Tailored Prenatal Care — Physician FAQs. 2025. ACOG Physician FAQ on Tailored Prenatal Care
- American College of Obstetricians and Gynecologists. Payment for Obstetric Services — 2026 to 2027 Coding Transition. ACOG Coding Guidance for the 2027 Maternity Care CPT Restructure
- Healio. ‘This is a generational change’: Why ACOG now recommends tailoring prenatal care. May 28, 2025. Healio Coverage from ACOG Annual Meeting 2025
- Policy Center for Maternal Mental Health. New Prenatal Care Guidelines Issued. April 25, 2025. Policy Center Response on Tailored Prenatal Care and Postpartum Gaps
- American Hospital Association. ACOG Releases New Guidance on Prenatal Care Delivery. AHA News, April 22, 2025. AHA Briefing on ACOG Prenatal Care Update