{"version":"v1","license":"CC-BY-4.0","attributionRequired":true,"dateModified":"2026-06-25","states":[{"stateCode":"AL","stateName":"Alabama","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Alabama does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"AK","stateName":"Alaska","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Alaska does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"AZ","stateName":"Arizona","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Arizona has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"FFS + MCO","sourceUrl":"https://www.azahcccs.gov/PlansProviders/OtherProviderProgramsAndInitiatives/Doula.html"},"ruleset":{"status":"active","programName":"AHCCCS doula services","effectiveDate":"2024-10-01","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/az","payment":{"model":"per_visit","claimable":true,"summary":"Doula services (per 15 minutes), up to eight units per day: $15.26; Doula services per diem (labor and delivery), once per 9-month period: $488.40","serviceLines":[{"code":"T1032","description":"Doula services (per 15 minutes), up to eight units per day","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1526,"maxUnits":8},{"code":"T1033","description":"Doula services per diem (labor and delivery), once per 9-month period","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":48840,"maxUnits":1}]},"documentationRequirements":["Hold ADHS doula certification and register with AHCCCS via APEP with a separate NPI.","Obtain an eligible provider referral (COS-01); an ICD-10 diagnosis is required on every claim.","Bill T1032 in 15-minute units, up to eight units per day; T1033 per diem is billable once within a 9-month period.","Labor and delivery (T1033) is in-person; no prior authorization.","AHCCCS is the payer of last resort; coverage extends to one year postpartum."],"sourceDocuments":[{"label":"AHCCCS Doula Services - DFSM Provider Training","publisher":"AHCCCS","version":"December 2, 2025; coverage effective October 1, 2024","accessedAt":"2026-06-15","url":"https://www.azahcccs.gov/Resources/Downloads/DFSMTraining/2025/DoulaServices.pdf"},{"label":"AHCCCS Notice of Public Information - FFS rate changes effective 10/1/2024","publisher":"AHCCCS","version":"Doula fee schedule: T1032 $15.26 per 15 minutes; T1033 $488.40 per diem","accessedAt":"2026-06-15","url":"https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/Preliminary_Public_Notice_Rate_Changes_20241001.pdf"}]}},{"stateCode":"AR","stateName":"Arkansas","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Arkansas has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2026","pathway":"FFS","sourceUrl":"https://humanservices.arkansas.gov/wp-content/uploads/Post-to-DHS-Website-Rule-311-Maternal-Health.pdf"},"ruleset":{"status":"draft","programName":"Arkansas Medicaid community-based doula services","effectiveDate":"2026-03-01","version":"2026.06.21-draft","guideUrl":"https://doulapaid.com/states/ar","payment":{"model":"pending_verification","claimable":false,"summary":"Arkansas DHS rule materials verify Medicaid reimbursement authority for certified community-based doulas, but claim-ready code, rate, and limit rows were not statically verified from a public Arkansas Medicaid fee schedule.","serviceLines":[]},"documentationRequirements":["Use Arkansas guide content for planning only until official Arkansas Medicaid procedure-code, rate, and limit rows are verified.","Confirm final certified community-based doula enrollment rules and any SPA effective-date details before enabling claim-ready packets.","Do not create Arkansas claim-ready packets from NHeLP/Axios coverage status alone; DoulaPaid requires code/rate evidence."],"sourceDocuments":[{"label":"Arkansas DHS Rule 311 Maternal Health","publisher":"Arkansas Department of Human Services","version":"Rule materials describing Medicaid reimbursement for certified community-based doulas and SPA retroactive submission to March 1, 2026","accessedAt":"2026-06-21","url":"https://humanservices.arkansas.gov/wp-content/uploads/Post-to-DHS-Website-Rule-311-Maternal-Health.pdf"},{"label":"NHeLP Doula Medicaid Project tracker","publisher":"National Health Law Program","version":"June 2026 landscape tracker; Arkansas listed as actively reimbursing","accessedAt":"2026-06-21","url":"https://healthlaw.org/doulamedicaidproject/"}]}},{"stateCode":"CA","stateName":"California","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"California has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2023","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Medi-Cal doula services","effectiveDate":"2024-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/ca","payment":{"model":"per_visit","claimable":true,"summary":"Extended initial visit, 90 minutes: $197.98; Prenatal or postpartum visit, up to eight visits: $162.11; Support during vaginal delivery: $685.07","serviceLines":[{"code":"Z1032","description":"Extended initial visit, 90 minutes","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":19798,"maxUnits":null},{"code":"Z1034","description":"Prenatal or postpartum visit, up to eight visits","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":16211,"maxUnits":null},{"code":"59409","description":"Support during vaginal delivery","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":68507,"maxUnits":null},{"code":"59612","description":"Support during vaginal delivery after previous caesarean section","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":76869,"maxUnits":null},{"code":"59620","description":"Support during caesarean section","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":79573,"maxUnits":null},{"code":"T1033","description":"Support during or after miscarriage","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":25085,"maxUnits":null},{"code":"59840","description":"Support during or after abortion","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":25085,"maxUnits":null},{"code":"T1032","description":"Extended postpartum support, up to 12 fifteen-minute units per visit","modifiers":["XP"],"unitType":"timed","unitMinutes":15,"rateCents":4053,"maxUnits":12},{"code":"Z1038","description":"Additional postpartum visits with a second recommendation, up to nine visits","modifiers":["XP"],"unitType":null,"unitMinutes":null,"rateCents":16211,"maxUnits":null}]},"documentationRequirements":["Keep the DHCS standing recommendation or a written recommendation in the member record before billing.","For Z1038 additional postpartum visits, retain the second recommendation before the added visits begin.","Use modifier XP on every doula claim line and choose a DHCS-listed diagnosis code for the service.","Document service date, start/end time or duration, nature of care, support provided, referrals, and why the note supports the billed time.","Verify the member's 14-character Medi-Cal BIC ID, eligibility month, and managed care plan before billing.","Bill FFS through Medi-Cal; bill managed care members only through contracted or otherwise arranged MCP pathways."],"sourceDocuments":[{"label":"DHCS Medi-Cal FFS Doula Billing Codes Chart","publisher":"California Department of Health Care Services","version":"2024 TRI rates for services provided on or after January 1, 2024","accessedAt":"2026-06-13","url":"https://www.dhcs.ca.gov/providers-partners/medi-cal-ffs-doula-billing-codes-chart/"},{"label":"DHCS Doula Providers","publisher":"California Department of Health Care Services","version":"Standing recommendation, PAVE enrollment, MCP contracting, and provider resources reviewed June 13, 2026","accessedAt":"2026-06-13","url":"https://www.dhcs.ca.gov/providers-partners/doula-providers/"},{"label":"Medi-Cal Provider Manual Part 2: Doula Services","publisher":"California Department of Health Care Services / Medi-Cal","version":"Updated through December 2025: diagnosis table, XP modifier, service caps, documentation, telehealth modifier references","accessedAt":"2026-06-13","url":"https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/0075B242-F893-41DB-A418-4129A274E46C/doula.pdf"},{"label":"DHCS Billing Tips for Doula Providers","publisher":"California Department of Health Care Services","version":"Updated October 17, 2024: BIC checks, RAD denial tips, diagnosis requirement, XP modifier reminder","accessedAt":"2026-06-13","url":"https://www.dhcs.ca.gov/wp-content/uploads/2025/10/Billing-Tips-Doulas.pdf"}]}},{"stateCode":"CO","stateName":"Colorado","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Colorado has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"FFS + MCO","sourceUrl":"https://hcpf.colorado.gov/doulas"},"ruleset":{"status":"active","programName":"Health First Colorado doula benefit","effectiveDate":"2024-07-01","version":"2026.06.18-current","guideUrl":"https://doulapaid.com/states/co","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal doula services (per 15 minutes): $25; Postpartum doula services (per 15 minutes): $25; Labor and delivery doula services (per delivery): $900","serviceLines":[{"code":"T1032","description":"Prenatal doula services (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":2500,"maxUnits":12},{"code":"T1032","description":"Postpartum doula services (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":2500,"maxUnits":12},{"code":"T1033","description":"Labor and delivery doula services (per delivery)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":90000,"maxUnits":1}]},"documentationRequirements":["Bill T1032 in 15-minute units for prenatal and postpartum direct member contact.","Colorado covers 12 T1032 units for prenatal services and 12 T1032 units for postpartum services per member pregnancy.","T1033 labor and delivery cannot be telemedicine."],"sourceDocuments":[{"label":"HCPF Doula Billing Manual","publisher":"Colorado Department of Health Care Policy & Financing","version":"Living manual; benefit effective July 1, 2024","accessedAt":"2026-06-18","url":"https://hcpf.colorado.gov/doula-manual"},{"label":"Health First Colorado January 2026 Fee Schedule PDF","publisher":"Colorado Department of Health Care Policy & Financing","version":"January 2026 fee schedule; updated 02/06/2026; T1032 $25, T1033 $900","accessedAt":"2026-06-18","url":"https://hcpf.colorado.gov/sites/hcpf/files/01_CO_Fee%20Schedule_Health%20First%20Colorado_01012026%20v1.0.pdf"}]}},{"stateCode":"CT","stateName":"Connecticut","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Connecticut has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"HUSKY Health certified doula services","effectiveDate":"2025-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/ct","payment":{"model":"per_visit","claimable":true,"summary":"Antepartum or postpartum doula visit: $100; Synchronous audio/video antepartum or postpartum doula visit: $100; In-person attendance at labor and delivery: $800","serviceLines":[{"code":"T1033","description":"Antepartum or postpartum doula visit","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":4},{"code":"T1033","description":"Synchronous audio/video antepartum or postpartum doula visit","modifiers":["95"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":2},{"code":"T1033","description":"In-person attendance at labor and delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":80000,"maxUnits":1}]},"documentationRequirements":["Retain a handwritten or electronic recommendation, referral, or order from a licensed and enrolled CMAP/HUSKY Health practitioner.","Document the member's name, address, birth date, Medicaid ID, pertinent diagnostic information, signed visit notes, services provided, service dates, location, and referral documentation.","Track four total antepartum/postpartum visits before prior authorization; additional medically necessary visits require PA before services are rendered.","Do not bill labor and delivery attendance by telemedicine; CT reimburses that line only for in-person attendance."],"sourceDocuments":[{"label":"CT DSS Provider Bulletin 2025-14: New Coverage of Certified Doulas","publisher":"Connecticut Department of Social Services","version":"Effective January 1, 2025; T1033 $100 perinatal visits, T1033-HD $800 labor/delivery, referral, PA, telemedicine, documentation, and fee schedule access","accessedAt":"2026-06-13","url":"https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb2025_14.pdf&URI=Bulletins%2Fpb2025_14.pdf"},{"label":"CT DSS Provider Bulletin 2025-05: DPH Doula Certification and Enrollment Criteria","publisher":"Connecticut Department of Social Services","version":"DPH certification and CMAP enrollment requirements for doulas","accessedAt":"2026-06-13","url":"https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=pb25_05.pdf&URI=Bulletins%2Fpb25_05.pdf"}]}},{"stateCode":"DE","stateName":"Delaware","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Delaware has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"MCO","sourceUrl":"https://www.delawarefirsthealth.com/providers/resources/doula-services.html"},"ruleset":{"status":"active","programName":"Delaware Medicaid doula services - Delaware First Health MCO","effectiveDate":"2025-04-02","version":"2026.06.21-current","guideUrl":"https://doulapaid.com/states/de","payment":{"model":"per_visit","claimable":true,"summary":"Delaware First Health prenatal doula visit, per 15 minutes: $15.83; Delaware First Health postpartum doula visit, per 15 minutes: $15.83; Delaware First Health attendance through labor and birth: $477","serviceLines":[{"code":"T1032","description":"Delaware First Health prenatal doula visit, per 15 minutes","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1583,"maxUnits":6},{"code":"T1032","description":"Delaware First Health postpartum doula visit, per 15 minutes","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1583,"maxUnits":6},{"code":"T1033","description":"Delaware First Health attendance through labor and birth","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":47700,"maxUnits":1},{"code":"T5999","description":"Delaware First Health incentive after all three prenatal visits, delivery attendance, and all three postpartum visits by the same doula","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":1}]},"documentationRequirements":["This claim-ready workflow is payer-specific to Delaware First Health; do not reuse these rates for AmeriHealth Caritas Delaware, Highmark Health Options, or another Delaware Medicaid MCO without a matching payer-rate source.","Complete DMAP MCO-Only provider enrollment and the Delaware First Health contracting process before billing.","Hold the Delaware Certification Board doula credential and an individual NPI with taxonomy 374J00000X.","Verify member eligibility before each service; Delaware First Health states authorizations and referrals are not required for standard doula services.","Prenatal and postpartum visits are capped at 90 minutes per visit; standard coverage includes up to three prenatal visits and up to three postpartum visits.","Use the Delaware First Health additional-postpartum-visit recommendation form before billing additional postpartum visits beyond the standard three-visit postpartum set.","The T5999 HD incentive requires the same doula to perform all three prenatal visits, attend the birth, and perform all three postpartum visits for the same member."],"sourceDocuments":[{"label":"Delaware First Health - Doula Services","publisher":"Delaware First Health (Delaware Medicaid MCO)","version":"Doula benefit and reimbursement page: T1032 $15.83 per 15-minute unit, T1033 $477, T5999 incentive $100","accessedAt":"2026-06-21","url":"https://www.delawarefirsthealth.com/providers/resources/doula-services.html"},{"label":"Delaware First Health Doula Quick Reference Guide","publisher":"Delaware First Health (Delaware Medicaid MCO)","version":"Updated October 2025; T1033, T1032, T1032 U1 value-added, T1032 HD postpartum, T5999 HD incentive, eligibility, authorization, and claims instructions","accessedAt":"2026-06-21","url":"https://www.delawarefirsthealth.com/content/dam/centene/delaware/provider-resource-guides/Updated%20Doula%20Quick%20Reference%20Guide_082725_R.pdf"},{"label":"Delaware SPA 25-0002","publisher":"Centers for Medicare & Medicaid Services / Delaware Medicaid","version":"Approved September 3, 2025; effective April 2, 2025; doula reimbursement methodology and state fee-schedule publication basis","accessedAt":"2026-06-21","url":"https://www.medicaid.gov/medicaid/spa/downloads/DE-25-0002.pdf"},{"label":"Delaware Certification Board - Doula","publisher":"Delaware Certification Board","version":"Doula credentialing requirements for Medicaid reimbursement","accessedAt":"2026-06-21","url":"https://www.decertboard.org/doula"},{"label":"Delaware Medical Assistance Program (DMAP) provider enrollment","publisher":"Delaware Division of Medicaid and Medical Assistance","version":"MCO-Only provider enrollment path for doulas","accessedAt":"2026-06-21","url":"https://medicaid.dhss.delaware.gov/provider/Home/ProviderEnrollment/tabid/477/Default.aspx"}]}},{"stateCode":"DC","stateName":"District of Columbia","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"District of Columbia has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2022","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"DC Medicaid doula services","effectiveDate":"2026-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/dc","payment":{"model":"per_visit","claimable":true,"summary":"Perinatal doula support visit: $107.89; Doula support at vaginal delivery: $762.98; Doula support at c-section delivery: $762.98","serviceLines":[{"code":"99600","description":"Perinatal doula support visit","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":10789,"maxUnits":12},{"code":"59400","description":"Doula support at vaginal delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":76298,"maxUnits":1},{"code":"59514","description":"Doula support at c-section delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":76298,"maxUnits":1},{"code":"59612","description":"Doula support at VBAC delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":76298,"maxUnits":1},{"code":"99199","description":"Postpartum doula support, 15-minute increment","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1348,"maxUnits":24},{"code":"99199","description":"Incentive payment for obstetric postpartum visit 7 to 84 days after labor and delivery","modifiers":["HD","U8"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":1}]},"documentationRequirements":["Confirm the beneficiary is eligible for DC Medicaid, Alliance, or Immigrant Children's Program coverage and keep the DC Medicaid beneficiary ID on the private client record.","Keep the physician or licensed practitioner recommendation that supports preventive doula services.","Document service date, service type, duration when billing postpartum 15-minute increments, support provided, care coordination, referrals, and next steps.","Track no more than 12 doula visits across the perinatal and postpartum period unless prior authorization is documented.","For the postpartum incentive, confirm at least one postpartum doula service and the obstetric postpartum visit 7 to 84 days after labor and delivery.","For fee-for-service submission, keep the doula NPI, DC Medicaid ID, beneficiary ID, procedure code, modifier, diagnosis code, and service units ready for the DC Medicaid web portal."],"sourceDocuments":[{"label":"DHCF Transmittal 25-36: Medicaid Doula Services Rate Change Effective January 1, 2026","publisher":"DC Department of Health Care Finance","version":"CY2026 rates effective January 1, 2026 through December 31, 2026","accessedAt":"2026-06-13","url":"https://dhcf.dc.gov/publication/transmittal-25-36-medicaid-doula-services-rate-change-effective-january-1-2026"},{"label":"DHCF Transmittal 25-36 PDF","publisher":"DC Department of Health Care Finance","version":"Rate table for 99600 HD, 59400 HD, 59514 HD, 59612 HD, 99199 HD, and 99199 HD U8","accessedAt":"2026-06-13","url":"https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/Transmittal%2025-36%20-%20Medicaid%20Doula%20Services%20Rate%20Change%20Effective%20January%201%2C%202026.pdf"},{"label":"DHCF Transmittal 22-34: Doula Benefit, Provider Qualifications, Rates and Reimbursement Standards","publisher":"DC Department of Health Care Finance","version":"Enrollment, provider qualification, visit limit, billing, and documentation standards effective October 1, 2022","accessedAt":"2026-06-13","url":"https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/Transmittal-22-34-Doula-Benefit-Provider-Qualifications-and-Enrollment-Rates-and-Reimbursement-Standards.pdf"}]}},{"stateCode":"FL","stateName":"Florida","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Florida has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"MCO","sourceUrl":"https://www.sunshinehealth.com/providers/Billing-manual/doula.html"},"ruleset":{"status":"draft","programName":"Florida Medicaid managed-care doula expanded benefits","effectiveDate":"2018-07-01","version":"2026.06.21-draft","guideUrl":"https://doulapaid.com/states/fl","payment":{"model":"pending_verification","claimable":false,"summary":"Florida doula coverage is plan-specific through managed-care expanded benefits; public MCO rate rows, codes, and statewide fee-schedule evidence were not verified.","serviceLines":[]},"documentationRequirements":["Use Florida guide content for plan screening only until a specific MCO's codes, rates, limits, authorization rules, and billing route are verified.","Confirm whether the member's Florida Medicaid managed-care plan offers doula services as an expanded benefit before service or claim planning.","Do not create Florida claim-ready packets from statewide coverage summaries alone; plan-specific payer evidence is required."],"sourceDocuments":[{"label":"Sunshine Health Doula Services Quick Reference Guide","publisher":"Sunshine Health / Florida Medicaid managed care","version":"Provider quick reference page confirming Sunshine Health doula coverage and covered service categories","accessedAt":"2026-06-21","url":"https://www.sunshinehealth.com/providers/Billing-manual/doula.html"},{"label":"Florida Senate 2026 SB 514 analysis","publisher":"Florida Senate","version":"Analysis noting Florida Medicaid managed-care plans may cover doula services as optional expanded benefits and many but not all plans offer coverage","accessedAt":"2026-06-21","url":"https://www.flsenate.gov/Session/Bill/2026/514/Analyses/2026s00514.pre.hp.PDF"}]}},{"stateCode":"GA","stateName":"Georgia","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Georgia does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"HI","stateName":"Hawaii","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Hawaii does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"ID","stateName":"Idaho","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Idaho does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"IL","stateName":"Illinois","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Illinois has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"MCO","sourceUrl":"https://hfs.illinois.gov/medicalproviders/notices/notice.prn241219b.html"},"ruleset":{"status":"active","programName":"Illinois Medicaid doula services","effectiveDate":"2024-02-01","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/il","payment":{"model":"per_visit","claimable":true,"summary":"Labor and delivery support - vaginal: $720; Labor and delivery support - cesarean: $720; Labor and delivery support - VBAC: $720","serviceLines":[{"code":"59409","description":"Labor and delivery support - vaginal","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":72000,"maxUnits":1},{"code":"59514","description":"Labor and delivery support - cesarean","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":72000,"maxUnits":1},{"code":"59612","description":"Labor and delivery support - VBAC","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":72000,"maxUnits":1},{"code":"59620","description":"Labor and delivery support - cesarean after attempted VBAC","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":72000,"maxUnits":1},{"code":"S9445","description":"Prenatal patient education (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1500,"maxUnits":null},{"code":"S9444","description":"Postpartum parenting education (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1500,"maxUnits":null},{"code":"59430","description":"Postpartum visit attendance with practitioner","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":5000,"maxUnits":2},{"code":"99381","description":"Initial newborn visit - facilitation and attendance","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":5000,"maxUnits":1},{"code":"T1032","description":"Doula support during or after miscarriage or abortion (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1500,"maxUnits":null}]},"documentationRequirements":["Become an Illinois Medicaid-Certified Doula (SIU) and enroll via IMPACT with taxonomy 374J00000X; bill FFS or HealthChoice Illinois MCOs.","Only one labor and delivery support unit (59409/59514/59612/59620) is payable per pregnancy.","Report the actual delivery date (837P Loop 2300, DTP*454) to receive 59430 postpartum attendance payment; up to two units per delivery.","Bill 99381 newborn visit under the newborn recipient ID (RIN) within two weeks of delivery.","NCCI procedure-to-procedure and medically-unlikely edits apply."],"sourceDocuments":[{"label":"HFS Fee Schedule For Doulas","publisher":"Illinois Department of Healthcare and Family Services (HFS)","version":"Effective 02/01/2024; updated 12/19/2024","accessedAt":"2026-06-15","url":"https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/12192024doulafs.pdf"},{"label":"HFS Provider Notice - Doula Services enrollment and coverage","publisher":"Illinois HFS","version":"Issued 12/19/2024","accessedAt":"2026-06-15","url":"https://hfs.illinois.gov/medicalproviders/notices/notice.prn241219b.html"}]}},{"stateCode":"IN","stateName":"Indiana","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Indiana does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"IA","stateName":"Iowa","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Iowa does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"KS","stateName":"Kansas","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Kansas has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"FFS + MCO","sourceUrl":"https://www.kdhe.ks.gov/m/newsflash/Home/Detail/1135"},"ruleset":{"status":"active","programName":"Kansas Medicaid (KanCare) doula services","effectiveDate":"2024-07-01","version":"2026.06.20-current","guideUrl":"https://doulapaid.com/states/ks","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal doula visits, per 15 minutes: $15; Attendance at labor and delivery: $500; Postpartum doula visits, per 15 minutes: $15","serviceLines":[{"code":"T1032","description":"Prenatal doula visits, per 15 minutes","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1500,"maxUnits":28},{"code":"T1033","description":"Attendance at labor and delivery","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":50000,"maxUnits":1},{"code":"T1032","description":"Postpartum doula visits, per 15 minutes","modifiers":["TS"],"unitType":"timed","unitMinutes":15,"rateCents":1500,"maxUnits":25}]},"documentationRequirements":["KanCare covers doula services for dates of service on and after July 1, 2024, from confirmed conception through one year postpartum.","Services must be recommended by a licensed practitioner before the doula service is rendered.","Use diagnosis Z33.1 for prenatal T1032 and T1033 labor/delivery, and diagnosis Z39.2 with modifier TS for postpartum T1032."],"sourceDocuments":[{"label":"KanCare - Kansas Medicaid Program Expands Coverage to Include Doula Services","publisher":"Kansas Department of Health and Environment / KanCare","version":"Doula coverage effective July 1, 2024","accessedAt":"2026-06-20","url":"https://www.kdhe.ks.gov/m/newsflash/Home/Detail/1135"},{"label":"KMAP Bulletin 24099 - Doulas Enrollment and Coverage","publisher":"Kansas Medical Assistance Program (KMAP)","version":"T1032 $15 per unit and T1033 $500","accessedAt":"2026-06-20","url":"https://portal.kmap-state-ks.us/Documents/Provider/Bulletins/24099%20%20-%20General%20-%20Doulas_Enrollment_and_Coverage.pdf"}]}},{"stateCode":"KY","stateName":"Kentucky","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Kentucky does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"LA","stateName":"Louisiana","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Louisiana has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2026","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Louisiana Medicaid doula services","effectiveDate":"2026-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/la","payment":{"model":"per_visit","claimable":true,"summary":"Pre/postnatal nurse advocacy visit, as medically necessary: $35.41; Prenatal/postpartum doula visit, part of the eight-visit pool: $69.69; Attendance at labor and delivery by doula: $459","serviceLines":[{"code":"99404","description":"Pre/postnatal nurse advocacy visit, as medically necessary","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":3541,"maxUnits":null},{"code":"S9445","description":"Prenatal/postpartum doula visit, part of the eight-visit pool","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":6969,"maxUnits":null},{"code":"99199","description":"Attendance at labor and delivery by doula","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":45900,"maxUnits":1},{"code":"S9442","description":"Birthing class, per session, part of the eight-visit pool","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":4080,"maxUnits":null},{"code":"S9443","description":"Lactation class, per session, part of the eight-visit pool","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":4080,"maxUnits":null},{"code":"S9444","description":"Parenting class, per session, part of the eight-visit pool","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":4080,"maxUnits":null}]},"documentationRequirements":["Verify Louisiana Medicaid eligibility and the correct FFS or Healthy Louisiana MCO submission path before billing.","Document the qualified doula's Louisiana Doula Registry Board status and Louisiana Medicaid enrollment.","Track S9445, S9442, S9443, and S9444 together because Louisiana counts those starred services toward eight total allowable visits, not including delivery.","Bill 99199 for one attendance at labor and delivery per pregnancy and document continuous in-person labor/delivery support."],"sourceDocuments":[{"label":"Louisiana Medicaid Professional Services Provider Manual","publisher":"Louisiana Department of Health / Louisiana Medicaid","version":"Chapter 5 Professional Services, Section 5.1, issued December 29, 2025; doula coverage, qualifications, codes, and visit limits","accessedAt":"2026-06-13","url":"https://www.lamedicaid.com/provweb1/providermanuals/manuals/ps/ps.pdf"},{"label":"Louisiana Medicaid Professional Services Fee Schedule","publisher":"Louisiana Department of Health / Gainwell","version":"Effective for dates of service on and after January 1, 2026; 99404 $35.41, S9445 $69.69, 99199 $459, S9442/S9443/S9444 $40.80","accessedAt":"2026-06-13","url":"https://www.lamedicaid.com/provweb1/fee_schedules/feesched.xlsx"},{"label":"Louisiana Medicaid Doula Provider Enrollment Notice","publisher":"Louisiana Department of Health","version":"Managed care coverage effective January 1, 2026; FFS coverage effective January 20, 2026; provider enrollment packets","accessedAt":"2026-06-13","url":"https://ldh.la.gov/news/doula-provider-enrollment"}]}},{"stateCode":"ME","stateName":"Maine","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"Maine has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/"},"ruleset":null},{"stateCode":"MD","stateName":"Maryland","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Maryland has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":"https://health.maryland.gov/mmcp/medicaid-mch-initiatives/Pages/DoulaProgram.aspx"},"ruleset":{"status":"active","programName":"Maryland Medicaid doula services","effectiveDate":"2023-07-01","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/md","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal doula visit, up to four 15-minute units: $16.62; Postpartum doula visit, up to four 15-minute units: $19.62; Labor and delivery attendance (in-person only): $800","serviceLines":[{"code":"T1032","description":"Prenatal doula visit, up to four 15-minute units","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":4},{"code":"T1032","description":"Postpartum doula visit, up to four 15-minute units","modifiers":["U9"],"unitType":"timed","unitMinutes":15,"rateCents":1962,"maxUnits":4},{"code":"T1033","description":"Labor and delivery attendance (in-person only)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":80000,"maxUnits":1}]},"documentationRequirements":["Enroll in ePREP as provider type \"DL\" (individual Type 1 NPI or group Type 2 NPI); maintain Maryland-approved certification, background check, and liability insurance.","Use diagnosis code Z32.2 on all doula service lines.","Bill prenatal/postpartum visits in 15-minute units, up to four units per visit; one visit equals up to four units.","Enforce the 8:1 model: a combined maximum of 8 perinatal visits (any prenatal + postpartum combination) plus one labor/delivery attendance.","Labor and delivery (T1033) is in-person hospital/birth-center only and is never billed as telehealth.","Prenatal/postpartum visits may be telehealth (modifier GT for HealthChoice; POS 02 accepted for FFS dual-eligibles).","If the pregnancy does not result in a live birth, unused prenatal/postpartum visits may be used toward postpartum/bereavement support."],"sourceDocuments":[{"label":"Maryland Medicaid Doula Services Program Manual","publisher":"Maryland Department of Health / Medicaid (MMCP)","version":"Updated January 13, 2026 (rates as of 7/1/2023); 8:1 model, codes/rates/modifiers, Z32.2, ePREP \"DL\", COMAR 10.09.39","accessedAt":"2026-06-15","url":"https://health.maryland.gov/mmcp/medicaid-mch-initiatives/Documents/Doulas/Doula%20Program%20Manual_01.13.26.pdf"},{"label":"Become a Doula Provider (MDH)","publisher":"Maryland Department of Health","version":"Doula provider enrollment information","accessedAt":"2026-06-15","url":"https://health.maryland.gov/mmcp/medicaid-mch-initiatives/Pages/DoulaProviderinformation.aspx"}]}},{"stateCode":"MA","stateName":"Massachusetts","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Massachusetts has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2023","pathway":"FFS + MCO","sourceUrl":"https://www.mass.gov/news/masshealth-announces-coverage-of-doula-services"},"ruleset":{"status":"active","programName":"MassHealth Doula Services","effectiveDate":"2023-12-08","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/ma","payment":{"model":"per_visit","claimable":true,"summary":"Perinatal visit up to 60 minutes: $100; Perinatal visit 61 to 90 minutes: $150; Labor and delivery support: $900","serviceLines":[{"code":"99600","description":"Perinatal visit up to 60 minutes","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":null},{"code":"99600","description":"Perinatal visit 61 to 90 minutes","modifiers":["TF"],"unitType":"flat","unitMinutes":null,"rateCents":15000,"maxUnits":null},{"code":"99199","description":"Labor and delivery support","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":90000,"maxUnits":1}]},"documentationRequirements":["Enroll as a MassHealth doula provider; bill FFS during the carve-out and per MCO/ACO contracts otherwise.","Use code 99600 for perinatal visits up to 60 minutes; add modifier TF for 61-90 minutes.","Perinatal visit payments may not exceed $800 per perinatal period per member without prior authorization (130 CMR 463.000).","Doula services are not covered for MassHealth Limited, CMSP, HSN, or MSP members.","Coverage runs through 12 months postpartum (all pregnancy outcomes; adoptive parents of infants under one year)."],"sourceDocuments":[{"label":"101 CMR 319.00 - Rates for Doula Services","publisher":"Massachusetts Executive Office of Health and Human Services","version":"Effective December 8, 2023; 99600 $100, 99600 TF $150, 99199 $900; $800 perinatal-period cap","accessedAt":"2026-06-15","url":"https://www.mass.gov/regulations/101-CMR-31900-rates-for-doula-services"},{"label":"MassHealth Doula Services Program - Information for Doulas","publisher":"MassHealth (MA EOHHS)","version":"Program coverage and provider information","accessedAt":"2026-06-15","url":"https://www.mass.gov/info-details/masshealth-doula-services-program-information-for-doulas"}]}},{"stateCode":"MI","stateName":"Michigan","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Michigan has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Michigan Medicaid doula initiative","effectiveDate":"2026-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/mi","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal or postpartum doula visit, 12 total visits before prior authorization: $100; Telemedicine-eligible prenatal or postpartum doula visit: $100; Attendance at labor and delivery, in-person: $1,500","serviceLines":[{"code":"S9445","description":"Prenatal or postpartum doula visit, 12 total visits before prior authorization","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":12},{"code":"S9445","description":"Telemedicine-eligible prenatal or postpartum doula visit","modifiers":["HD","95"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":12},{"code":"T1033","description":"Attendance at labor and delivery, in-person","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":150000,"maxUnits":1}]},"documentationRequirements":["Submit fee-for-service claims in CHAMPS and follow Medicaid Health Plan billing instructions for managed-care members.","Use S9445 with modifier HD for prenatal and postpartum visits; use diagnosis Z33.1 for prenatal and Z39.2 for postpartum.","Use T1033 with modifier HD and diagnosis Z33.1 for in-person labor and delivery attendance.","Track the 12 total prenatal/postpartum visit limit before prior authorization; DoulaPaid blocks the prior authorization path until PA fields are added.","Keep start and end time, professional service description, recommendation source or statewide standing recommendation basis, and doula record details for at least seven years.","For telemedicine S9445 visits, confirm the service followed MDHHS telemedicine policy and include modifier 95."],"sourceDocuments":[{"label":"MDHHS Doula Fee Schedule","publisher":"Michigan Department of Health and Human Services","version":"January 2026 fee schedule: S9445 HD $100, T1033 HD $1,500","accessedAt":"2026-06-13","url":"https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/January-2026-DBs/Doula-012026.xlsx"},{"label":"MDHHS Doula Billing Guidance","publisher":"Michigan Department of Health and Human Services","version":"CHAMPS billing, diagnosis codes, HD modifier, telemedicine modifier 95, and labor/delivery restrictions","accessedAt":"2026-06-13","url":"https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Maternal-and-Infant-Health/Doula-Billing-Guidance-11-8-2024-Final.pdf"},{"label":"MDHHS Doula Provider FAQ Guidance","publisher":"Michigan Department of Health and Human Services","version":"Registry, CHAMPS enrollment, statewide standing recommendation, documentation, 12 visits plus prior authorization path","accessedAt":"2026-06-13","url":"https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Maternal-and-Infant-Health/Doula-Provider-FAQ-Guidance_Final.pdf"}]}},{"stateCode":"MN","stateName":"Minnesota","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Minnesota has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2019","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Minnesota Medical Assistance doula services","effectiveDate":"2024-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/mn","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal, postpartum, or non-labor doula session: $100; Labor and delivery doula session: $1,400","serviceLines":[{"code":"T1033","description":"Prenatal, postpartum, or non-labor doula session","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":18},{"code":"T1033","description":"Labor and delivery doula session","modifiers":["U4"],"unitType":"flat","unitMinutes":null,"rateCents":140000,"maxUnits":1}]},"documentationRequirements":["Document the member's name, visit date, length of time, what was done, discussed, and recommended, important concerns or follow-up advice, and the doula signature.","Use T1033 without a modifier for non-labor and non-delivery sessions.","Use T1033 with U4 for labor and delivery sessions, including emergency Cesarean delivery when the doula attended the labor.","Request prior authorization before providing more than 18 sessions.","For telehealth labor and delivery billing, keep the signed DHS telehealth assurance statement and document that the doula was available throughout labor."],"sourceDocuments":[{"label":"Minnesota Health Care Programs Provider Manual","publisher":"Minnesota Department of Human Services","version":"Doula Services page revised September 16, 2025; T1033 / T1033+U4; 18 sessions without PA","accessedAt":"2026-06-22","url":"https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_190890"},{"label":"Minnesota Statutes 256B.758 Payment for Doula Services","publisher":"Minnesota Office of the Revisor of Statutes","version":"MN Stat. 256B.758: $100 per prenatal/postpartum visit and $1,400 for attending birth, effective January 1, 2024 (canonical HTML cite; /pdf variant retired after fetch failure; re-verified 2026-06-22)","accessedAt":"2026-06-22","url":"https://www.revisor.mn.gov/statutes/cite/256B.758/pdf"}]}},{"stateCode":"MS","stateName":"Mississippi","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Mississippi does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"MO","stateName":"Missouri","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Missouri has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"FFS + MCO","sourceUrl":"https://mydss.mo.gov/mhd/doulas"},"ruleset":{"status":"active","programName":"MO HealthNet doula services","effectiveDate":"2024-10-01","version":"2026.06.18-current","guideUrl":"https://doulapaid.com/states/mo","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal support session, 60 minutes or more: $75; Postpartum support session, 60 minutes or more: $75; Attendance at labor and delivery, up to 24 hours: $800","serviceLines":[{"code":"S9445","description":"Prenatal support session, 60 minutes or more","modifiers":["TH"],"unitType":"flat","unitMinutes":null,"rateCents":7500,"maxUnits":6},{"code":"S9445","description":"Postpartum support session, 60 minutes or more","modifiers":["TS"],"unitType":"flat","unitMinutes":null,"rateCents":7500,"maxUnits":6},{"code":"T1033","description":"Attendance at labor and delivery, up to 24 hours","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":80000,"maxUnits":1}]},"documentationRequirements":["MO HealthNet doula services require a physician or other licensed practitioner recommendation.","Support sessions are limited to six combined prenatal and postpartum sessions.","T1033 is the usual birth-attendance code for up to 24 hours."],"sourceDocuments":[{"label":"MO HealthNet Doula Program","publisher":"Missouri Department of Social Services / MO HealthNet Division","version":"Benefit effective for dates of service on or after 10/01/2024","accessedAt":"2026-06-18","url":"https://mydss.mo.gov/mhd/doulas"},{"label":"MO HealthNet Medical Services Fee Schedule","publisher":"Missouri Department of Social Services / MO HealthNet Division","version":"Medical Services fee schedule rows effective 10/01/2024 for S9443, S9445 TH/TS, S9482, T1032, T1033","accessedAt":"2026-06-18","url":"https://apps.dss.mo.gov/fmsfeeschedules/DLFiles.aspx"}]}},{"stateCode":"MT","stateName":"Montana","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"Montana has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/"},"ruleset":null},{"stateCode":"NE","stateName":"Nebraska","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"Nebraska has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://healthlaw.org/doulamedicaidproject/"},"ruleset":null},{"stateCode":"NV","stateName":"Nevada","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Nevada has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":"https://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/Doula%20Providers_ADA.pdf"},"ruleset":{"status":"active","programName":"Nevada Medicaid doula services - Provider Type 90","effectiveDate":"2023-10-01","version":"2026.06.18-current","guideUrl":"https://doulapaid.com/states/nv","payment":{"model":"per_visit","claimable":true,"summary":"Patient education, individual, per session: $100; Doula support at vaginal delivery: $900","serviceLines":[{"code":"S9445","description":"Patient education, individual, per session","modifiers":["U1"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":4},{"code":"59409","description":"Doula support at vaginal delivery","modifiers":["U1"],"unitType":"flat","unitMinutes":null,"rateCents":90000,"maxUnits":1}]},"documentationRequirements":["Bill Provider Type 90 doula services with modifier U1.","S9445 is limited to four visits without prior authorization.","Do not append TN after 2025-08-25."],"sourceDocuments":[{"label":"Nevada Medicaid Provider Type 90 Doula Fee Schedule","publisher":"Nevada Medicaid / DHCFP","version":"PT 90 fee schedule dated 04/2026; S9445 U1 $100; delivery codes U1 $900","accessedAt":"2026-06-18","url":"https://www.nevadamedicaid.nv.gov/siteassets/content/resources/rates/pt-90-fee-schedule-042026.xlsx"},{"label":"Provider Type 90 Billing Guide - Doula Services","publisher":"Nevada Medicaid / DHCFP","version":"Updated 11/13/2024","accessedAt":"2026-06-18","url":"https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT90_online_111324.pdf"}]}},{"stateCode":"NH","stateName":"New Hampshire","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"New Hampshire has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/"},"ruleset":null},{"stateCode":"NJ","stateName":"New Jersey","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"New Jersey has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2021","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"NJ FamilyCare doula services","effectiveDate":"2026-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/nj","payment":{"model":"per_visit","claimable":true,"summary":"Initial prenatal doula visit, up to six 15-minute units: $16.62; Standard prenatal doula visit, up to four 15-minute units: $16.62; Standard postpartum doula visit, up to four 15-minute units: $16.62","serviceLines":[{"code":"99600","description":"Initial prenatal doula visit, up to six 15-minute units","modifiers":["HD","U7"],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":6},{"code":"99600","description":"Standard prenatal doula visit, up to four 15-minute units","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":4},{"code":"99199","description":"Standard postpartum doula visit, up to four 15-minute units","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":4},{"code":"59409","description":"Attendance at vaginal delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":50000,"maxUnits":1},{"code":"59514","description":"Attendance at cesarean delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":50000,"maxUnits":1},{"code":"99199","description":"Postpartum continuity incentive payment","modifiers":["HD","U8"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":1},{"code":"99600","description":"Enhanced-care prenatal doula visit for members age 19 or younger at first service","modifiers":["HD","22"],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":4},{"code":"99199","description":"Enhanced-care postpartum doula visit for members age 19 or younger at first service","modifiers":["HD","22"],"unitType":"timed","unitMinutes":15,"rateCents":1662,"maxUnits":4}]},"documentationRequirements":["All NJ FamilyCare doulas must enroll as fee-for-service providers and be able to serve fee-for-service members before MCO contracting.","Retain the licensed-practitioner recommendation before providing preventive doula services.","Use diagnosis code Z32.2 on all NJ FamilyCare doula claim lines.","Bill prenatal and postpartum visits in 15-minute units; the initial visit allows up to six units, and standard/enhanced visits allow up to four units.","Standard care allows up to eight prenatal/postpartum visits including the optional initial prenatal visit, plus one delivery attendance line.","Enhanced care allows four additional prenatal/postpartum visits when the member was 19 or younger at the first doula service.","Bill the postpartum incentive only when a postpartum doula visit occurs within six weeks of delivery and the obstetric clinician follow-up requirement is tracked.","Submit FFS claims by 837P, Direct Data Entry, or paper CMS-1500 through NJMMIS/Gainwell; use the member's MCO path when applicable."],"sourceDocuments":[{"label":"NJ DMAHS Doula Care Provider Overview","publisher":"New Jersey Division of Medical Assistance and Health Services","version":"NJ FamilyCare doula benefit, FFS directory and MCO directory references, provider resources","accessedAt":"2026-06-13","url":"https://www.nj.gov/humanservices/dmahs/providers-stakeholders/overview/doula.shtml"},{"label":"NJ DMAHS Provider Newsletter Vol. 31 No. 4: Doula Care","publisher":"New Jersey Division of Medical Assistance and Health Services","version":"Revised billing codes, diagnosis Z32.2, standard/enhanced visit limits, recommendation requirement, and submission routes","accessedAt":"2026-06-13","url":"https://nj.gov/humanservices/dmahs/documents/providers-stakeholders/Newsletter_31-04_Doula.pdf"},{"label":"NJ DOH Community Doula Provider Steps","publisher":"New Jersey Department of Health","version":"FFS enrollment first, approved training, supplemental community competency, background check, liability insurance, MCO contracting after FFS","accessedAt":"2026-06-13","url":"https://www.nj.gov/health/doulas/how-to-become-a-nj-familycare-doula-provider/"}]}},{"stateCode":"NM","stateName":"New Mexico","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"New Mexico has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"MCO","sourceUrl":"https://www.hca.nm.gov/turquoise-care/"},"ruleset":{"status":"active","programName":"New Mexico Medicaid Turquoise Care doula services","effectiveDate":"2024-10-01","version":"2026.06.20-current","guideUrl":"https://doulapaid.com/states/nm","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal or postpartum doula services, per 15 minutes: $25; Other doula counseling and coordination services, per 15 minutes: $25; Labor and delivery doula services: $1,500","serviceLines":[{"code":"T1032","description":"Prenatal or postpartum doula services, per 15 minutes","modifiers":["U1"],"unitType":"timed","unitMinutes":15,"rateCents":2500,"maxUnits":8},{"code":"T1032","description":"Other doula counseling and coordination services, per 15 minutes","modifiers":["U2"],"unitType":"timed","unitMinutes":15,"rateCents":2500,"maxUnits":8},{"code":"T1033","description":"Labor and delivery doula services","modifiers":["U3"],"unitType":"flat","unitMinutes":null,"rateCents":150000,"maxUnits":1}]},"documentationRequirements":["SPA 24-0004 requires doula preventive services to be recommended by a physician or other licensed practitioner; keep the recommendation in the record.","New Mexico doula billing is claim-ready only for contracted Turquoise Care MCO workflows; no statewide FFS fee-schedule path is enabled.","Use T1032 U1/U2 and T1033 U3 according to the member's MCO billing guidance, diagnosis mapping, and unit limits."],"sourceDocuments":[{"label":"NMDOH Doula Program","publisher":"New Mexico Department of Health","version":"Medicaid reimbursement and certification page","accessedAt":"2026-06-20","url":"https://www.nmhealth.org/about/phd/fhb/mch/doula/"},{"label":"New Mexico SPA 24-0004","publisher":"Centers for Medicare & Medicaid Services / New Mexico Medicaid","version":"Approved 12/05/2024; effective 10/01/2024","accessedAt":"2026-06-20","url":"https://www.medicaid.gov/medicaid/spa/downloads/NM-24-0004.pdf"},{"label":"2025 Doula and Lactation Provider Managed Care Reference Guide","publisher":"Turquoise Care MCOs with NMDOH partners","version":"T1032 U1/U2 $25 per 15-minute unit, T1033 U3 $1,500","accessedAt":"2026-06-20","url":"https://nmdoula.org/wp-content/uploads/2025/07/Statewide-Doula-Toolkit.pdf"}]}},{"stateCode":"NY","stateName":"New York","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"New York has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"New York Medicaid doula services","effectiveDate":"2024-03-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/ny","payment":{"model":"per_visit","claimable":true,"summary":"New York City perinatal support visit, minimum 30 minutes: $93.75; Rest of State perinatal support visit, minimum 30 minutes: $84.37; New York City in-person labor and delivery support: $750","serviceLines":[{"code":"T1032","description":"New York City perinatal support visit, minimum 30 minutes","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":9375,"maxUnits":8},{"code":"T1032","description":"Rest of State perinatal support visit, minimum 30 minutes","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":8437,"maxUnits":8},{"code":"T1033","description":"New York City in-person labor and delivery support","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":75000,"maxUnits":1},{"code":"T1033","description":"Rest of State in-person labor and delivery support","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":67500,"maxUnits":1}]},"documentationRequirements":["For dates of service on or after 2025-04-01, bill the member's Medicaid Managed Care plan directly when the member is in MMC; use FFS/eMedNY only when the member is in FFS.","For T1032 perinatal visits, document at least 30 minutes of prenatal or postpartum doula support and use Z32.2 or Z32.3 as appropriate.","For T1033 labor and delivery, document in-person support during labor and birth, one unit, and use Z32.2.","Track no more than eight perinatal visits and one labor/delivery encounter per pregnancy/postpartum benefit period.","Keep the eMedNY provider NPI, member CIN, service date, procedure code, diagnosis code, and one billed unit ready for claim entry."],"sourceDocuments":[{"label":"eMedNY Doula Services Benefit Policy Manual","publisher":"eMedNY / New York State Department of Health","version":"March 2026","accessedAt":"2026-06-22","url":"https://www.emedny.org/ProviderManuals/Doula/PDFS/Doula_Policy_Guidelines.pdf"},{"label":"eMedNY Doula Services Billing Guidelines","publisher":"eMedNY / New York State Department of Health","version":"Current doula billing guidelines","accessedAt":"2026-06-22","url":"https://www.emedny.org/ProviderManuals/Doula/PDFS/Doula_Billing_Guidelines.pdf"},{"label":"New York State Medicaid Fee-for-Service Doula Services Fee Schedule","publisher":"eMedNY / New York State Department of Health","version":"T1032 and T1033 rates effective March 1, 2024","accessedAt":"2026-06-22","url":"https://www.emedny.org/ProviderManuals/Doula/PDFS/Doula_Fee_Schedule.xlsx"}]}},{"stateCode":"NC","stateName":"North Carolina","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"North Carolina does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"ND","stateName":"North Dakota","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"North Dakota does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"OH","stateName":"Ohio","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Ohio has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2024","pathway":"MCO","sourceUrl":"https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families%2C%20Individuals/Programs/MISP/12-18-2025_FINAL_All_MCO_Doula_Resource_Guide.pdf"},"ruleset":{"status":"active","programName":"Ohio Medicaid doula services","effectiveDate":"2024-10-03","version":"2026.06.21-current","guideUrl":"https://doulapaid.com/states/oh","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal and postpartum doula services, per 15 minutes: $12.50; Labor and delivery doula services: $600","serviceLines":[{"code":"T1032","description":"Prenatal and postpartum doula services, per 15 minutes","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1250,"maxUnits":48},{"code":"T1033","description":"Labor and delivery doula services","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":60000,"maxUnits":1}]},"documentationRequirements":["Use the Ohio Medicaid MCO route for claim-ready packets; confirm the member's plan, portal, and plan-specific enrollment before billing.","ODM's all-MCO guide lists T1032 at $12.50 per 15-minute unit with up to 48 units before prior authorization is required for additional units.","Use T1033 for labor and delivery support at $600 per delivery.","The guide lists diagnosis codes Z34.x, O80.0, or Z32.2 for doula services; verify the diagnosis selected matches the encounter and payer instructions.","Ohio doulas must be certified by the Ohio Board of Nursing and complete Medicaid/MCO enrollment or credentialing before reimbursement."],"sourceDocuments":[{"label":"Ohio Medicaid All MCO Doula Resource Guide","publisher":"Ohio Department of Medicaid and Ohio Medicaid managed-care organizations","version":"Approved December 18, 2025; T1032 $12.50 per 15-minute unit up to 48 units, T1033 $600","accessedAt":"2026-06-21","url":"https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families%2C%20Individuals/Programs/MISP/12-18-2025_FINAL_All_MCO_Doula_Resource_Guide.pdf"},{"label":"Ohio Medicaid MISP Services Overview","publisher":"Ohio Department of Medicaid","version":"Services overview PDF; doula services available to pregnant and postpartum Ohio Medicaid members","accessedAt":"2026-06-21","url":"https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Families%2C%20Individuals/Programs/MISP/MISP_Services_Overview_V_2.1_FINAL_DRAFT_3.16.2026_Clean.pdf"}]}},{"stateCode":"OK","stateName":"Oklahoma","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Oklahoma has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2023","pathway":"FFS + MCO","sourceUrl":"https://oklahoma.gov/ohca/individuals/programs/pregnancy-services/doula-services.html"},"ruleset":{"status":"active","programName":"Oklahoma SoonerCare doula services","effectiveDate":"2023-07-01","version":"2026.06.22-current","guideUrl":"https://doulapaid.com/states/ok","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal doula visit (60-minute minimum): $62.11; Postpartum doula visit (60-minute minimum): $62.11; Labor and delivery doula support - vaginal delivery: $685.69","serviceLines":[{"code":"59899","description":"Prenatal doula visit (60-minute minimum)","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":6211,"maxUnits":8},{"code":"59899","description":"Postpartum doula visit (60-minute minimum)","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":6211,"maxUnits":8},{"code":"59409","description":"Labor and delivery doula support - vaginal delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":68569,"maxUnits":1},{"code":"59514","description":"Labor and delivery doula support - cesarean delivery","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":77628,"maxUnits":1},{"code":"59612","description":"Labor and delivery doula support - VBAC","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":77528,"maxUnits":1},{"code":"59620","description":"Labor and delivery doula support - cesarean after attempted VBAC","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":80267,"maxUnits":1}]},"documentationRequirements":["OHCA written confirmation dated June 22, 2026 verifies 59899/HD reimburses $62.11 for prenatal and postpartum doula visits, with the rate increasing to $67.81 for dates of service on or after July 1, 2026.","Complete and retain the SoonerCare doula referral form recommending doula services.","Bill 8 prenatal/postpartum visits (60-minute minimum, face-to-face or telehealth) plus 1 labor and delivery visit; prior authorization is required beyond 8 visits.","Use 59899 with modifier HD for prenatal and postpartum visits; use Z32.2 for prenatal and labor/delivery and Z32.3 for postpartum.","Labor and delivery may not be telehealth. Select the delivery code that matches the delivery type: 59409, 59514, 59612, or 59620 with modifier HD."],"sourceDocuments":[{"label":"OHCA SoonerCare - Doula Services","publisher":"Oklahoma Health Care Authority","version":"Doula benefit effective July 1, 2023; 8 visits + 1 labor/delivery","accessedAt":"2026-06-19","url":"https://oklahoma.gov/ohca/individuals/programs/pregnancy-services/doula-services.html"},{"label":"Doulas and SoonerCare provider training","publisher":"Oklahoma Health Care Authority","version":"June 2023; covered procedure codes, referral, and visit requirements","accessedAt":"2026-06-19","url":"https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/2023/doula%206.8_sd%20updated.pdf"},{"label":"OHCA SoonerCare Fee Schedule","publisher":"Oklahoma Health Care Authority","version":"2026 Title XIX public file: 59409 $685.69, 59514 $776.28, 59612 $775.28, 59620 $802.67; 59899 shown as manual-priced publicly","accessedAt":"2026-06-22","url":"https://oklahoma.gov/ohca/providers/claim-tools/fee-schedule.html"},{"label":"OHCA written 59899/HD reimbursement confirmation","publisher":"Oklahoma Health Care Authority","version":"Email from OHCA Provider Education Specialist Nora Boxx dated June 22, 2026: 59899 reimburses $62.11; rate increases to $67.81 July 1, 2026","accessedAt":"2026-06-22","url":"https://oklahoma.gov/ohca/providers/claim-tools/fee-schedule.html"}]}},{"stateCode":"OR","stateName":"Oregon","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Oregon has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Oregon Health Plan birth doula services","effectiveDate":"2025-01-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/or","payment":{"model":"global_fee","claimable":true,"summary":"$1,505 global package.","serviceLines":[{"code":"T1033","description":"Global doula benefit with support at delivery","modifiers":["HD"],"unitType":null,"unitMinutes":null,"rateCents":150500,"maxUnits":null},{"code":"T1033","description":"Support visit","modifiers":[],"unitType":null,"unitMinutes":null,"rateCents":21500,"maxUnits":null},{"code":"T1033","description":"Doula services day of delivery only","modifiers":["22"],"unitType":null,"unitMinutes":null,"rateCents":64500,"maxUnits":null}]},"documentationRequirements":["Track whether the global package is complete before billing the global line.","If the global package is not complete, itemize partial support and delivery-only services.","For every encounter, include service dates, education or services provided, needs beyond routine care, and referrals made.","For labor and delivery, include the doula's name and length of time services were provided during labor and delivery.","Bill Oregon FFS on a professional claim; CCO members may have plan-specific billing instructions.","Do not send client names, IDs, visit notes, or claim details to any AI or research tool."],"sourceDocuments":[{"label":"OHA Birth Doula Fee-for-Service Billing Guide","publisher":"Oregon Health Authority, Health Systems Division","version":"January 2025; T1033+HD global $1,505 / support visit $215 / day-of-delivery $645","accessedAt":"2026-06-13","url":"https://www.oregon.gov/oha/HSD/OHP/Tools/Doula-Billing-Guide.pdf"},{"label":"Oregon Administrative Rule 410-130-0015, Doula Services","publisher":"Oregon Secretary of State / Oregon Health Authority","version":"Current rule reviewed June 13, 2026","accessedAt":"2026-06-13","url":"https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=321636"}]}},{"stateCode":"PA","stateName":"Pennsylvania","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Pennsylvania has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2025","pathway":"FFS + MCO","sourceUrl":"https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/publications/documents/forms-and-pubs-omap/mab2024122309.pdf"},"ruleset":{"status":"active","programName":"Pennsylvania Medical Assistance doula services","effectiveDate":"2025-01-01","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/pa","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal visit (minimum 30 minutes): $100; Postpartum visit (minimum 30 minutes): $100; Other doula services/support (minimum 30 minutes): $175","serviceLines":[{"code":"T1032","description":"Prenatal visit (minimum 30 minutes)","modifiers":["U7"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":null},{"code":"T1032","description":"Postpartum visit (minimum 30 minutes)","modifiers":["U8"],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":null},{"code":"T1032","description":"Other doula services/support (minimum 30 minutes)","modifiers":["U9"],"unitType":"flat","unitMinutes":null,"rateCents":17500,"maxUnits":2},{"code":"T1033","description":"Labor and delivery support (in-person; delivery must occur)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":100000,"maxUnits":1}]},"documentationRequirements":["Enroll as a certified perinatal doula in MA (provider type 13, specialty 130); bill via PROMISe or MA MCOs.","T1032 must carry a pricing modifier: U7 prenatal, U8 postpartum, or U9 other services; each visit must be at least 30 minutes.","Keep the Doula Services Recommendation Form on file.","Initial prenatal visit and first postpartum visit must be in person; T1033 must be in person and is paid only when delivery occurs.","Combined prenatal + postpartum visits are limited to 12 per calendar year; other services limited to two; no prior authorization."],"sourceDocuments":[{"label":"PA MA Bulletin - Coverage of and Payment for Doula Services in the MA Program","publisher":"Pennsylvania DHS / OMAP","version":"Issued December 23, 2024; effective January 1, 2025; T1032 U7 $100, U8 $100, U9 $175, T1033 $1,000","accessedAt":"2026-06-15","url":"https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/publications/documents/forms-and-pubs-omap/mab2024122309.pdf"},{"label":"PA Certification Board - Perinatal Doula","publisher":"Pennsylvania Certification Board","version":"Certified perinatal doula requirement","accessedAt":"2026-06-15","url":"https://www.pacertboard.org/doula"}]}},{"stateCode":"RI","stateName":"Rhode Island","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Rhode Island has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":null,"pathway":"FFS + MCO","sourceUrl":"https://eohhs.ri.gov/providers-partners/provider-directories/doula-services"},"ruleset":{"status":"active","programName":"Rhode Island Medicaid doula services","effectiveDate":"2023-07-01","version":"2026.06.15-current","guideUrl":"https://doulapaid.com/states/ri","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal doula visit, 60-minute minimum: $100; Labor and delivery doula support (vaginal): $900; Labor and delivery doula support (cesarean): $900","serviceLines":[{"code":"S9445","description":"Prenatal doula visit, 60-minute minimum","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":1},{"code":"59400","description":"Labor and delivery doula support (vaginal)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":90000,"maxUnits":1},{"code":"59510","description":"Labor and delivery doula support (cesarean)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":90000,"maxUnits":1},{"code":"S9446","description":"Postnatal doula visit, 60-minute minimum","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":10000,"maxUnits":1}]},"documentationRequirements":["Bill only visits of 60 minutes or more; document the date, time/duration, and nature of each visit.","Verify RI Medicaid eligibility on each date of service.","Enroll via the RI Medicaid Healthcare Portal with NPI taxonomy 374J00000X and RICB certification; complete Trading Partner enrollment for electronic claims.","For In-Plan managed care members, submit to the member's MCO; an MCO may require a modifier on the CPT/HCPCS codes.","The per-pregnancy maximum is $1,500 (3 prenatal + 1 labor/delivery + 3 postnatal); unused prenatal/L&D visits may be billed as postnatal visits up to 7 postnatal total.","No reimbursement for home births/deliveries. For members under age 21, additional medically necessary visits may be requested via prior authorization."],"sourceDocuments":[{"label":"RI Medicaid Doula Services Manual V1.3","publisher":"Rhode Island EOHHS / Medicaid","version":"Version 1.3, March 2026; procedure codes and rates unchanged from V1.2 (S9445 / 59510 / 59400 / S9446)","accessedAt":"2026-06-15","url":"https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2026-03/Doula%20Services%20Manual%20March%202026.pdf"},{"label":"EOHHS Doula Services provider page","publisher":"Rhode Island EOHHS","version":"Enrollment via RI Medicaid Healthcare Portal, taxonomy 374J00000X, RICB certificate + W-9 requirements","accessedAt":"2026-06-15","url":"https://eohhs.ri.gov/providers-partners/provider-directories/doula-services"}]}},{"stateCode":"SC","stateName":"South Carolina","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"South Carolina does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"SD","stateName":"South Dakota","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"South Dakota has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2025","pathway":"FFS","sourceUrl":"https://dss.sd.gov/docs/medicaid/providers/billingmanuals/Professional/Doula_Services.pdf"},"ruleset":{"status":"active","programName":"South Dakota Medicaid doula services","effectiveDate":"2025-01-01","version":"2026.06.19-current","guideUrl":"https://doulapaid.com/states/sd","payment":{"model":"per_visit","claimable":true,"summary":"Prenatal, postpartum, or care coordination doula services (per 15 minutes): $16.87; Labor and delivery doula services (per delivery): $600","serviceLines":[{"code":"T1032","description":"Prenatal, postpartum, or care coordination doula services (per 15 minutes)","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1687,"maxUnits":106},{"code":"T1033","description":"Labor and delivery doula services (per delivery)","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":60000,"maxUnits":1}]},"documentationRequirements":["Doula services require a referral from a physician, physician assistant, certified nurse practitioner, or certified nurse midwife with whom the recipient had a face-to-face or telemedicine visit within the last 90 days (or the care management program provider for BabyReady, Primary Care Provider Program, or Care Connect members); referrals may be retroactive up to 60 days.","Bill T1032 in 15-minute units; a unit is attained only when the 8-minute midpoint is passed, and same-day time is cumulative across visits.","South Dakota Medicaid covers a maximum of $1,800 of doula services per pregnancy (per recipient within an 18-month period); exceeding it requires prior authorization via the General Prior Authorization Form.","One T1033 labor and delivery visit is covered per recipient per pregnancy; the doula must be physically present and L&D must be billed in conjunction with prenatal and/or postpartum services.","Postpartum services may be provided up to 365 days after the end of pregnancy; care coordination, prenatal, and postpartum services may be face-to-face, telemedicine (GT modifier), or two-way audio-only (93 modifier) when documented.","Submit on a CMS-1500 or 837P; claims must be filed within 6 months of the date of service and records retained for at least 6 years."],"sourceDocuments":[{"label":"SD Medicaid Doula Services Billing and Policy Manual","publisher":"South Dakota Department of Social Services / SD Medicaid","version":"Updated December 2025; doula benefit effective January 1, 2025; T1032 timed unit, T1033 labor/delivery, $1,800 per-pregnancy cap, referral within 90 days","accessedAt":"2026-06-19","url":"https://dss.sd.gov/docs/medicaid/providers/billingmanuals/Professional/Doula_Services.pdf"},{"label":"SD Medicaid Doula Services Fee Schedule","publisher":"South Dakota Department of Social Services / SD Medicaid","version":"Doula Services fee schedule (Current SFY): T1032 $16.87 per 15-minute unit, T1033 $600 per delivery","accessedAt":"2026-06-19","url":"https://dss.sd.gov/medicaid/providers/feeschedules/"}]}},{"stateCode":"TN","stateName":"Tennessee","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"Tennessee has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/"},"ruleset":null},{"stateCode":"TX","stateName":"Texas","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Texas does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"UT","stateName":"Utah","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Utah has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2026","pathway":"FFS + MCO","sourceUrl":"https://health.utah.gov/stplan/lookup/FeeScheduleDownload.php"},"ruleset":{"status":"active","programName":"Utah Medicaid doula services","effectiveDate":"2026-04-01","version":"2026.06.20-current","guideUrl":"https://doulapaid.com/states/ut","payment":{"model":"per_visit","claimable":true,"summary":"Pregnancy and postpartum doula services, per 15 minutes: $11.59; Labor support doula services, per diem: $834.28","serviceLines":[{"code":"T1032","description":"Pregnancy and postpartum doula services, per 15 minutes","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":1159,"maxUnits":32},{"code":"T1033","description":"Labor support doula services, per diem","modifiers":[],"unitType":"flat","unitMinutes":null,"rateCents":83428,"maxUnits":1}]},"documentationRequirements":["Utah's Medicaid doula benefit is effective for dates of service on and after April 1, 2026 (CMS-approved SPA).","Complete the Utah Medicaid Doula Provider Attestation and enroll in PRISM under the new doula provider type with an individual NPI.","T1032 pregnancy/postpartum services are limited to 32 units per year and T1033 labor support is limited to one unit per year."],"sourceDocuments":[{"label":"Utah Medicaid Doula Provider Attestation","publisher":"Utah Department of Health and Human Services / Medicaid","version":"March 2026; doula provider enrollment attestation","accessedAt":"2026-06-20","url":"https://medicaid-documents.dhhs.utah.gov/Documents%2Fpdfs%2FForms%2FDoula%2BProvider%2BAttestation_3.2026.pdf"},{"label":"Utah Medicaid PRISM Release Notes 2026","publisher":"Utah Department of Health and Human Services / Medicaid","version":"Updated 05/04/2026; new doula PAC and provider type, T1032/T1033 opened","accessedAt":"2026-06-20","url":"https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/PRISM%20Release%20Notes%202026%20(updated%2005.04.2026).pdf"},{"label":"Utah Medicaid Fee Schedule Download","publisher":"Utah Department of Health and Human Services / Medicaid","version":"Generated 2026-06-20 for Traditional plan / PAC 180 Doula: T1032 $11.59, T1033 $834.28","accessedAt":"2026-06-20","url":"https://health.utah.gov/stplan/lookup/FeeScheduleDownload.php"}]}},{"stateCode":"VT","stateName":"Vermont","dateModified":"2026-06-25","coverage":{"status":"implementing","label":"Implementing","context":"Vermont has implementation or approval evidence in the DoulaPaid public coverage dataset, but claim-ready rates and codes are not shown until verified from official sources.","since":null,"pathway":null,"sourceUrl":"https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/"},"ruleset":null},{"stateCode":"VA","stateName":"Virginia","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Virginia has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2022","pathway":"FFS + MCO","sourceUrl":null},"ruleset":{"status":"active","programName":"Virginia Medicaid doula services","effectiveDate":"2025-07-01","version":"2026.06.13-current","guideUrl":"https://doulapaid.com/states/va","payment":{"model":"per_visit","claimable":true,"summary":"Initial prenatal doula visit, up to six 15-minute units: $14.99; Standard prenatal doula visit, up to four 15-minute units: $14.99; Postpartum doula visit, up to four 15-minute units: $14.99","serviceLines":[{"code":"99600","description":"Initial prenatal doula visit, up to six 15-minute units","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1499,"maxUnits":6},{"code":"59425","description":"Standard prenatal doula visit, up to four 15-minute units","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1499,"maxUnits":4},{"code":"59430","description":"Postpartum doula visit, up to four 15-minute units","modifiers":["HD"],"unitType":"timed","unitMinutes":15,"rateCents":1499,"maxUnits":4},{"code":"59409","description":"Labor support, vaginal birth","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":35000,"maxUnits":1},{"code":"59514","description":"Labor support, c-section","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":35000,"maxUnits":1},{"code":"99199","description":"Birthing parent postpartum clinician-visit incentive","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":5000,"maxUnits":1},{"code":"99199","description":"Newborn pediatric clinician-visit incentive","modifiers":["HD"],"unitType":"flat","unitMinutes":null,"rateCents":5000,"maxUnits":1}]},"documentationRequirements":["Retain the licensed-practitioner recommendation for doula care before services begin; the recommendation is not a prior authorization.","Submit or retain the DMAS doula care form according to FFS or the member's MCO process before initiating services.","Document the member's Virginia Medicaid eligibility, service date, duration, service type, support provided, referrals, care coordination, and follow-up plan.","Track one initial prenatal visit, three standard prenatal visits, six postpartum visits, one delivery support line, and the two postpartum incentive paths.","Use diagnosis code Z32.2 for Virginia Medicaid doula claim lines."],"sourceDocuments":[{"label":"Virginia DMAS Procedure Fee Files & CPT Codes","publisher":"Virginia Department of Medical Assistance Services","version":"Procedure fee files updated June 11, 2026; DOULA rows: 99600/59425/59430 at $14.99 per 15-minute unit, 59409/59514 at $350, 99199 incentive at $50","accessedAt":"2026-06-13","url":"https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/procedure-fee-files-cpt-codes/"},{"label":"Virginia DMAS Community Doula Program","publisher":"Virginia Department of Medical Assistance Services","version":"Provider certification, NPI, Medicaid enrollment, liability insurance, MCO contracting, licensed-practitioner recommendation, no prior authorization, eligibility, and training resources","accessedAt":"2026-06-13","url":"https://www.dmas.virginia.gov/for-members/benefits-and-services/maternal-and-child-health/community-doula-program/"},{"label":"DMAS Bulletin: Maternal Health Bills and Budget Items Effective July 1, 2025","publisher":"Virginia Department of Medical Assistance Services","version":"Postpartum doula visits increased 4 to 6, coverage window extended to 12 months postpartum, and 59430-HD with diagnosis Z32.2 identified","accessedAt":"2026-06-13","url":"https://vamedicaid.dmas.virginia.gov/bulletin/maternal-health-bills-and-budget-items-effective-july-1-2025"},{"label":"Virginia SPA 21-013 Doula Services","publisher":"Virginia Department of Medical Assistance Services / CMS","version":"State plan authority for doula benefit, visit-unit structure, incentives, and published fee-schedule method","accessedAt":"2026-06-13","url":"https://www.medicaid.gov/medicaid/spa/downloads/VA-21-0013.pdf"}]}},{"stateCode":"WA","stateName":"Washington","dateModified":"2026-06-25","coverage":{"status":"covered","label":"Covered","context":"Washington has a documented Medicaid doula benefit in the DoulaPaid public coverage dataset. Use the state guide and official source before billing.","since":"2022","pathway":"FFS + MCO","sourceUrl":"https://www.hca.wa.gov/billers-providers-partners/program-information-providers/doulas"},"ruleset":{"status":"active","programName":"Apple Health birth doula services","effectiveDate":"2025-10-01","version":"2025.10.01-current","guideUrl":"https://doulapaid.com/states/wa","payment":{"model":"unit_based","claimable":true,"summary":"$25 per 15-minute unit, up to 80 units.","serviceLines":[{"code":"59899","description":"Prenatal intake visit","modifiers":["U1"],"unitType":"flat","unitMinutes":15,"rateCents":75000,"maxUnits":null},{"code":"T1033","description":"Labor and delivery support","modifiers":[],"unitType":"flat","unitMinutes":15,"rateCents":75000,"maxUnits":null},{"code":"T1032","description":"Additional prenatal and postpartum visits","modifiers":[],"unitType":"timed","unitMinutes":15,"rateCents":2500,"maxUnits":80}]},"documentationRequirements":["Document the date, duration, nature of care, coordination with medical or community resources, and referrals.","Preserve enough detail to support every billed service line.","Verify client Apple Health eligibility before claim review.","Track the 20-hour / 80-unit prenatal and postpartum visit limit, including 6 units designated for postpartum care.","Document in-person prerequisites before billing later telemedicine visits; audio-only telemedicine is not covered."],"sourceDocuments":[{"label":"Washington HCA Provider Billing Guides and Fee Schedules","publisher":"Washington State Health Care Authority","version":"Birth doula services billing guide and fee schedule index reviewed June 26, 2026; confirm the latest HCA row before billing","accessedAt":"2026-06-26","url":"https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules"},{"label":"Washington HCA Birth Doula Services Billing Guide","publisher":"Washington State Health Care Authority","version":"April 1, 2026","accessedAt":"2026-06-26","url":"https://www.hca.wa.gov/assets/billers-and-providers/birth-doula-services-bg-20260401.pdf"},{"label":"Washington HCA Birth Doula Services Fee Schedule","publisher":"Washington State Health Care Authority","version":"January 1, 2025 to present; published December 30, 2024","accessedAt":"2026-06-26","url":"https://www.hca.wa.gov/assets/billers-and-providers/birth-doula-services-20250101.xlsx"}]}},{"stateCode":"WV","stateName":"West Virginia","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"West Virginia does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"WI","stateName":"Wisconsin","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Wisconsin does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null},{"stateCode":"WY","stateName":"Wyoming","dateModified":"2026-06-25","coverage":{"status":"not_documented","label":"Not documented","context":"Wyoming does not have a verified Medicaid doula benefit in the DoulaPaid public official-source dataset as of June 2026. DoulaPaid does not show rates, codes, or claim tools for this state until official payer sources support them.","since":null,"pathway":null,"sourceUrl":null},"ruleset":null}]}