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Delaware billing rules 2026.06.21-current

Delaware Medicaid doula billing rules

Check Delaware rates, codes, setup steps, visit-note basics, and denial risks before claim entry.

Updated Jun 21, 2026Sources checked within 90 days
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26 live state guidesSources checked within 90 daysLast updated Jun 21, 2026
Set up provider details first.
Check rates, visit notes, and claim gaps.
Use denied-claim help when a payer sends a reason code.

Quick path

Start with the step you need.

  1. 1Find the rule for your stateStart with the state where the client has Medicaid coverage.Choose your state
  2. 2Check what is missingReview setup, visit notes, codes, and payer steps before billing.Use the checklist
  3. 3Save the checklistDownload the checklist, then keep client details in your own secure records.Open checklist

Delaware Medicaid doula billing rules

Delaware uses per-visit service lines such as Delaware First Health prenatal doula visit, per 15 minutes at $15.83, with modifiers, caps, and documentation checks to confirm before claim entry.

Recently updated

Updated Jun 21, 2026Official source packet

Coverage and billing rules are tied to official state or payer sources.

  • Checked Delaware First Health (Delaware Medicaid MCO): Delaware First Health - Doula Services.
  • Checked Delaware First Health (Delaware Medicaid MCO): Delaware First Health Doula Quick Reference Guide.
  • Checked Centers for Medicare & Medicaid Services / Delaware Medicaid: Delaware SPA 25-0002.

Paid by visit

Delaware First Health prenatal doula visit, per 15 minutes: $15.83

Delaware First Health postpartum doula visit, per 15 minutes: $15.83 with modifier HD

Delaware First Health attendance through labor and birth: $477

Delaware First Health incentive after all three prenatal visits, delivery attendance, and all three postpartum visits by the same doula: $100 with modifier HD

What to check before billing

  • 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.

This page is built from checked state billing sources.

Use nicknames on public pages.

Keep client names, IDs, claim numbers, and visit notes in your own records.

Provider setup

These state tools are available for planning. Confirm payer requirements before billing.

Launch status

active

Active: guide and tools are ready for general planning.

Billing portal

DMAP MCO-Only enrollment; Delaware First Health provider portal

  • Confirm DMAP MCO-Only enrollment; Delaware First Health provider portal access and provider enrollment before first-claim work.
  • Keep NPI / DMAP MCO provider ID in your own secure records.
  • Keep Delaware Medicaid (DMAP) member ID, names, dates of birth, and visit notes out of public pages.
Open Delaware setup checklistFind health plan linksJump to official sources

Payout estimator

Model common claim totals from verified published rates. Keep client-specific details in your own secure records.

Planning estimator

Estimate a claim total

Use published rates to model Delaware services before claim entry. Do not enter client names, IDs, dates of birth, or visit notes here.

Estimated total

$608.66

Final payment still depends on eligibility, payer edits, documentation, and claim review.

State tools

Choose the question you need help with now.

Provider setup checklist

Enrollment and provider details checklist.

Claim checklist worksheet

Download a plain text checklist.

Check missing items

Find setup, eligibility, rate, and note gaps.

Rate reference

See how this state pays.

Check visit-note requirements

See what the note must support.

Fix denied claims

State-specific denial reasons.

Denied claim help

Review common denial reasons and the next step to check.

Read the Delaware denial reasons guide

Wrong Delaware MCO rate source

Confirm the member is enrolled with Delaware First Health or switch to the correct payer's verified rate source before claim entry.

DMAP/MCO enrollment incomplete

Finish DMAP MCO-Only enrollment and Delaware First Health contracting before billing.

Visit exceeds 90-minute cap

Cap the billed units at six for the visit or document why the service must be handled through a plan-specific exception path.

Incentive requirements not met

Confirm every required encounter is complete and attributable to the same doula before using T5999 HD.

Common questions

Plain answers about Delaware Medicaid doula billing.

Does Delaware Medicaid cover doula services?

Yes. Delaware Medicaid doula services - Delaware First Health MCO covers doula services. Coverage still depends on active eligibility, the service date, provider setup, and visit notes.

How much does Delaware Medicaid pay doulas?

Delaware pays per visit — 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; Delaware First Health incentive after all three prenatal visits, delivery attendance, and all three postpartum visits by the same doula: $100. Use the Delaware rate reference to check current amounts against official sources.

What should my Delaware visit note include?

Delaware lists 7 visit-note checks to review before claim entry, starting with: 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.. See the Delaware visit-note checklist for the full list.

Why do Delaware doula Medicaid claims get denied?

Common reasons include wrong delaware mco rate source; dmap/mco enrollment incomplete; visit exceeds 90-minute cap. The Delaware denied-claim guide lists the next step for each.

Rule change alerts

Get a no-PHI email when Delaware doula billing rules change or new verified sources are added.

Do not include client details. This signup stores only the state and email address.

Official sources

Check these official sources before billing.

Source review

Source review current

Delaware sources on this page were last checked Jun 21, 2026. Use the linked payer sources as the source of truth before billing.

These payer links were checked within the last 90 days.

How we verify these rules

Delaware First Health - Doula ServicesDelaware First Health (Delaware Medicaid MCO) · Doula benefit and reimbursement page: T1032 $15.83 per 15-minute unit, T1033 $477, T5999 incentive $100 · checked Jun 21, 2026Delaware First Health Doula Quick Reference GuideDelaware First Health (Delaware Medicaid MCO) · Updated October 2025; T1033, T1032, T1032 U1 value-added, T1032 HD postpartum, T5999 HD incentive, eligibility, authorization, and claims instructions · checked Jun 21, 2026Delaware SPA 25-0002Centers for Medicare & Medicaid Services / Delaware Medicaid · Approved September 3, 2025; effective April 2, 2025; doula reimbursement methodology and state fee-schedule publication basis · checked Jun 21, 2026Delaware Certification Board - DoulaDelaware Certification Board · Doula credentialing requirements for Medicaid reimbursement · checked Jun 21, 2026Delaware Medical Assistance Program (DMAP) provider enrollmentDelaware Division of Medicaid and Medical Assistance · MCO-Only provider enrollment path for doulas · checked Jun 21, 2026

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