MMM (maternity / no global)

The CMS Medicare Physician Fee Schedule assigns every procedure code a global surgery indicator. Most surgical codes carry a 0-, 10-, or 90-day global period. Maternity codes are different: they receive the MMM indicator, which signals that the standard day-count rules are replaced by obstetric-specific time frames tied to pregnancy physiology—roughly 280 days (40 gestational weeks) of antepartum care and up to 42 days (6 weeks) postpartum, depending on the specific code.

In practical terms, MMM means the 'no global' label is a shorthand for 'no ordinary surgical global'—not that there is zero bundling. Full-package codes (e.g., routine obstetric care including antepartum, delivery, and postpartum) bundle an enormous scope of service under one code. Partial or split-billing codes (antepartum-only, delivery-only, postpartum-only) carry narrower MMM windows. When a single provider or group practice with a written on-call agreement furnishes all three phases of care, the complete global OB package code is required; billing the components separately is improper in that scenario.

Beginning January 1, 2027, the AMA is deleting the legacy global OB package codes and replacing them with unbundled evaluation and management codes plus new phase-specific maternity categories. The MMM indicator will still appear on some surviving codes, but the sweeping bundled-package model that defined maternity coding since the mid-1990s will no longer exist. For orthopedic coders who encounter pregnant patients—trauma, spine surgery, fracture care—understanding MMM is critical to avoid inadvertently bundling or denying services that overlap with an active maternity global period.

If an orthopedic surgeon treats a pregnant patient for a covered orthopedic condition (e.g., an acute fracture or post-traumatic spine surgery), payors may incorrectly bundle that claim into the open MMM global period managed by the patient's OB provider, resulting in a denial. Conversely, an orthopedic practice that performs a procedure assigned an MMM indicator—rare but possible in combined service contexts—must understand that the pre- and post-operative bundling windows are governed by gestational weeks, not the 0/10/90-day rules used for every other specialty. Misreading MMM as 'no rules apply' rather than 'different rules apply' is a direct path to underpayment, claim denial, or a payor audit for improper unbundling.