Prior authorization
Medicaid doula prior authorization, in plain language.
Use this guide when you are not sure whether a Medicaid doula visit needs prior authorization, prior approval, a referral, or a recommendation.
Start here
Short answer
Use this guide when you are not sure whether a Medicaid doula visit needs prior authorization, prior approval, a referral, or a recommendation.
Next step
Before you bill extra or unusual services
Use these checks before assuming a claim is ready.
Start with the state
Prior authorization rules are different by state and payer. Use the state where the client is covered.
Do not mix up terms
A recommendation, referral, standing order, and prior authorization can mean different things.
Check before extra visits
Some states allow a set number of visits first, then require approval before more visits.
Keep proof private
Keep referrals, recommendations, approval notes, and client details in private records.
State starting points
Open the state guide before using this for a real claim packet.
Arizona
Labor and delivery (T1033) is in-person; no prior authorization.
Referral or recommendation note: Document the provider referral and an ICD-10 diagnosis on every claim; no prior authorization.
California
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: A second recommendation is required for up to nine additional postpartum visits billed with Z1038.
Colorado
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Use Z33.1 for prenatal and delivery services and Z39.2 for postpartum services; T1032 telemedicine is allowed with payer modifiers, while T1033 cannot be telemedicine.
Connecticut
Prior authorization may be needed after 4 sessions.
Referral or recommendation note: Retain the handwritten or electronic licensed-practitioner recommendation, referral, or order before billing.
District of Columbia
Prior authorization may be needed after 12 sessions.
Referral or recommendation note: Recommendation by a physician or other licensed practitioner of the healing arts is required for DC Medicaid preventive doula services.
Illinois
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Report the delivery date for postpartum attendance; bill the newborn visit under the newborn RIN. NCCI edits apply.
Louisiana
Prior authorization may be needed after 8 sessions.
Referral or recommendation note: Verify member Medicaid eligibility and retain documentation supporting the medically necessary doula service.
Maryland
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Use diagnosis Z32.2 on all services and verify the member is pregnant or within 180 days postpartum.
Massachusetts
Perinatal visit payments may not exceed $800 per perinatal period per member without prior authorization (130 CMR 463.000).
Referral or recommendation note: Use code 99600 (add modifier TF for 61-90 minute visits); perinatal payments may not exceed $800 per perinatal period per member without prior authorization.
Michigan
Prior authorization may be needed after 12 sessions.
Referral or recommendation note: No separate individual recommendation is required when the statewide standing recommendation applies; keep the recommendation basis in the record.
Minnesota
Prior authorization may be needed after 18 sessions.
Referral or recommendation note: Statewide MHCP standing recommendation; no individual physician referral or written recommendation required for eligible members.
Missouri
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Keep the recommendation letter on file before billing; use current MO HealthNet manual limits and monthly fee schedule rows.
Nevada
Prior authorization may be needed after 4 sessions.
Referral or recommendation note: Bill PT 90 doula services with U1. Do not append TN for rural members after 2025-08-25; urban/rural payment is assigned from member ZIP.
New Jersey
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Retain the licensed-practitioner recommendation, verify NJ FamilyCare eligibility, and confirm the member is not in NJSPCP.
New Mexico
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Use the MCO guide for planning only until the HCA fee schedule/rate source is verified; claim-ready billing remains blocked.
New York
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Statewide standing order; use Z32.2 for prenatal/labor and Z32.3 for postpartum where the eMedNY fee schedule requires it.
Oregon
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: Verify OHP eligibility before service or billing; contact the member's CCO for CCO-specific billing instructions.
Pennsylvania
Combined prenatal + postpartum visits are limited to 12 per calendar year; other services limited to two; no prior authorization.
Referral or recommendation note: Keep the Doula Services Recommendation Form on file; T1032 must carry a U7/U8/U9 pricing modifier. No prior authorization.
Rhode Island
No reimbursement for home births/deliveries. For members under age 21, additional medically necessary visits may be requested via prior authorization.
Referral or recommendation note: Verify RI Medicaid eligibility on each date of service; MCO claims may require a modifier on the CPT/HCPCS codes.
Virginia
Prior authorization may be needed after 10 sessions.
Referral or recommendation note: Retain the signed DMAS doula care recommendation form and provide it to FFS or the member's MCO before services begin.
Washington
No prior authorization limit is listed in the current DoulaPaid state summary. Still check payer instructions before providing or billing services.
Referral or recommendation note: VERIFY
Next pages
These pages help turn the approval question into a claim packet check.
Common questions
Do Medicaid doula services need prior authorization?
It depends on the state, payer, visit count, and service type. Start with the client state and check payer instructions before providing or billing services that may need approval.
Is a referral the same as prior authorization?
Not always. A referral or recommendation may support the service, while prior authorization usually means payer approval before certain services. The exact meaning depends on the state and payer.
Can I put approval documents into public tools?
No. Use public pages for learning. Keep client names, Medicaid IDs, referrals, recommendations, and approval documents in private records.