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Massachusetts billing rules 2026.06.15-current

Massachusetts Medicaid doula billing rules

Massachusetts Medicaid doula billing uses per-visit rates starting at $100.

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Short answer

Massachusetts Medicaid doula billing uses per-visit rates starting at $100.

Next step

Find the rule for your stateStart with the state where the client has Medicaid coverage.Choose a stateCheck what is neededUse the checklist to sort setup, visit notes, codes, and payer details.Open checklistKeep client work privateUse planning tools without client identifiers. Keep private details in approved records.Open worksheet

Massachusetts Medicaid doula billing rules

Massachusetts Medicaid doula billing uses per-visit rates starting at $100.

Per-visit model

Perinatal visit up to 60 minutes: $100

Perinatal visit 61 to 90 minutes: $150 with modifier TF

Labor and delivery support: $900

What to check before billing

  • 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).

This page is built from checked state billing sources.

Public tools are for general checks. Keep client details in your own records.

Launch status and setup

Massachusetts is marked active. Check setup before claim work.

Launch status

active

Active: state tools are ready for general planning.

Billing portal

MassHealth (POSC); FFS and MCO/ACO pathways

  • Confirm MassHealth (POSC); FFS and MCO/ACO pathways access and provider enrollment before packet work.
  • Keep MassHealth provider ID / NPI in private records only.
  • Never enter MassHealth member ID, names, dates of birth, or visit notes into public tools.

Free state tools

Pick the tool that matches the question you have now.

Provider setup

Enrollment and billing profile checklist.

Packet worksheet

Plan the packet.

Claim checker

Packet review checklist.

Rate calculator

Payment model explainer.

Visit note checklist

Visit note checklist.

Denial pages

State-specific denial reasons.

Denied claim help

Review common denial reasons and the next step to check.

Read the Massachusetts denial reasons guide

Perinatal payment cap exceeded

Confirm prior payments or obtain prior authorization before billing.

Wrong perinatal visit modifier

Confirm documented duration and correct the modifier.

Coverage type excludes doula services

Verify coverage type before billing.

Documentation does not support service

Complete the visit note before submission.

Common questions

Plain answers about Massachusetts Medicaid doula billing.

Does Massachusetts Medicaid cover doula services?

Yes. MassHealth Doula Services covers doula services. Coverage still depends on the client's active eligibility, the service date, provider setup, and documentation.

How much does Massachusetts Medicaid pay doulas?

Massachusetts pays per visit — Perinatal visit up to 60 minutes: $100; Perinatal visit 61 to 90 minutes: $150; Labor and delivery support: $900. Use the Massachusetts rate calculator to check current amounts against official sources.

What documentation does Massachusetts require for doula claims?

Massachusetts expects 5 visit-note items before a packet is ready, including: Enroll as a MassHealth doula provider; bill FFS during the carve-out and per MCO/ACO contracts otherwise. See the Massachusetts visit-note checklist for the full list.

Why do Massachusetts doula Medicaid claims get denied?

Common reasons include perinatal payment cap exceeded; wrong perinatal visit modifier; coverage type excludes doula services. The Massachusetts denied-claim guide lists the next step for each.

Source trail

Published rules must stay attached to payer or policy sources.

Source review

Source review current

Massachusetts sources on this page were last checked 2026-06-17. Use the linked payer sources as the source of truth before billing a real claim.

The attached payer-source review is within the 90-day monitoring window.

How we verify these rules

101 CMR 319.00 - Rates for Doula ServicesMassachusetts Executive Office of Health and Human Services · Effective December 8, 2023; 99600 $100, 99600 TF $150, 99199 $900; $800 perinatal-period cap · checked 2026-06-15MassHealth Doula Services Program - Information for DoulasMassHealth (MA EOHHS) · Program coverage and provider information · checked 2026-06-15

Next steps

Use these Massachusetts pages after reading the state guide.

Check what is missingReview setup, service details, visit notes, and state-specific packet risks.OpenCalculate reimbursementUse the public rate reference before preparing a packet.OpenCheck visit notesSee what the visit note needs before claim work.OpenSee denial reasonsMatch common denial risks to prevention steps.OpenPlan a packetUse the worksheet before claim entry.Open

Export this state guide

Billing tools can download a PDF with rates, codes, documentation requirements, denial reasons, and source citations.

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