Massachusetts billing rules 2026.06.15-current
Massachusetts Medicaid doula billing rules
Check Massachusetts rates, codes, setup steps, visit-note basics, and denial risks before claim entry.
Quick path
Start with the step you need.
- 1Find the rule for your stateStart with the state where the client has Medicaid coverage.Choose your state
- 2Check what is missingReview setup, visit notes, codes, and payer steps before billing.Use the checklist
- 3Save the checklistDownload the checklist, then keep client details in your own secure records.Open checklist
Massachusetts Medicaid doula billing rules
Massachusetts uses per-visit service lines such as Perinatal visit up to 60 minutes at $100, with modifiers, caps, and documentation checks to confirm before claim entry.
Recently updated
Updated Jun 15, 2026Official fee scheduleRates are backed by official published fee-schedule or rate evidence in the source packet.
- Checked Massachusetts Executive Office of Health and Human Services: 101 CMR 319.00 - Rates for Doula Services.
- Checked MassHealth (MA EOHHS): MassHealth Doula Services Program - Information for Doulas.
Paid by visit
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.
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
MassHealth (POSC); FFS and MCO/ACO pathways
- Confirm MassHealth (POSC); FFS and MCO/ACO pathways access and provider enrollment before first-claim work.
- Keep MassHealth provider ID / NPI in your own secure records.
- Keep MassHealth member ID, names, dates of birth, and visit notes out of public pages.
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 Massachusetts services before claim entry. Do not enter client names, IDs, dates of birth, or visit notes here.
Estimated total
$1,150.00
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.
Prior authorization
Check whether approval is needed.
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.
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 active eligibility, the service date, provider setup, and visit notes.
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 reference to check current amounts against official sources.
What should my Massachusetts visit note include?
Massachusetts lists 5 visit-note checks to review before claim entry, starting with: 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.
Rule change alerts
Get a no-PHI email when Massachusetts 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 currentMassachusetts sources on this page were last checked Jun 17, 2026. Use the linked payer sources as the source of truth before billing.
These payer links were checked within the last 90 days.
Need a PDF copy?
PDF export is in the paid tools, where saved state guides and checklist downloads stay with your account.