Maryland billing rules 2026.06.15-current
Maryland Medicaid doula billing rules
Check Maryland rates, codes, setup steps, visit-note basics, and denial risks before claim entry.
Quick path
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- 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
Maryland Medicaid doula billing rules
Maryland uses per-visit service lines such as Prenatal doula visit, up to four 15-minute units at $16.62, 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 Maryland Department of Health / Medicaid (MMCP): Maryland Medicaid Doula Services Program Manual.
- Checked Maryland Department of Health: Become a Doula Provider (MDH).
Paid by visit
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.
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
ePREP / FFS Medicaid and HealthChoice MCO pathways
- Confirm ePREP / FFS Medicaid and HealthChoice MCO pathways access and provider enrollment before first-claim work.
- Keep Maryland Medicaid provider ID / NPI in your own secure records.
- Keep Maryland Medicaid 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 Maryland services before claim entry. Do not enter client names, IDs, dates of birth, or visit notes here.
Estimated total
$800.00
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.
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.
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 active eligibility, the service date, provider setup, and visit notes.
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 reference to check current amounts against official sources.
What should my Maryland visit note include?
Maryland lists 7 visit-note checks to review before claim entry, starting with: 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.
Rule change alerts
Get a no-PHI email when Maryland doula billing rules change or new verified sources are added.
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Official sources
Check these official sources before billing.
Source review
Source review currentMaryland 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.