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Maryland billing rules 2026.06.15-current

Maryland Medicaid doula billing rules

Maryland Medicaid doula billing uses per-visit rates starting at $16.62.

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Short answer

Maryland Medicaid doula billing uses per-visit rates starting at $16.62.

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

Maryland Medicaid doula billing rules

Maryland Medicaid doula billing uses per-visit rates starting at $16.62.

Per-visit model

Prenatal doula visit, up to four 15-minute units: $16.62

Postpartum doula visit, up to four 15-minute units: $19.62 with modifier U9

Labor and delivery attendance (in-person only): $800

What to check before billing

  • 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.

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

Maryland is marked active. Check setup before claim work.

Launch status

active

Active: state tools are ready for general planning.

Billing portal

ePREP / FFS Medicaid and HealthChoice MCO pathways

  • Confirm ePREP / FFS Medicaid and HealthChoice MCO pathways access and provider enrollment before packet work.
  • Keep Maryland Medicaid provider ID / NPI in private records only.
  • Never enter Maryland Medicaid member ID, names, dates of birth, or visit notes into public tools.

Free state tools

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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 Maryland denial reasons guide

Not ePREP-enrolled "DL" or not certified

Complete ePREP enrollment and approved certification before billing.

Member not eligible

Confirm eligibility on the date of service.

Perinatal visit cap reached

Confirm the combined perinatal visit count before billing additional visits.

Labor/delivery billed as telehealth

Bill T1033 only for in-person hospital/birth-center attendance.

Missing Z32.2 diagnosis

Add Z32.2 before submission.

Common questions

Plain answers about Maryland Medicaid doula billing.

Does Maryland Medicaid cover doula services?

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

How much does Maryland Medicaid pay doulas?

Maryland pays per visit — 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. Use the Maryland rate calculator to check current amounts against official sources.

What documentation does Maryland require for doula claims?

Maryland expects 7 visit-note items before a packet is ready, including: 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. See the Maryland visit-note checklist for the full list.

Why do Maryland doula Medicaid claims get denied?

Common reasons include not eprep-enrolled "dl" or not certified; member not eligible; perinatal visit cap reached. The Maryland 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

Maryland 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

Maryland Medicaid Doula Services Program ManualMaryland Department of Health / Medicaid (MMCP) · Updated January 13, 2026 (rates as of 7/1/2023); 8:1 model, codes/rates/modifiers, Z32.2, ePREP "DL", COMAR 10.09.39 · checked 2026-06-15Become a Doula Provider (MDH)Maryland Department of Health · Doula provider enrollment information · checked 2026-06-15

Next steps

Use these Maryland 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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