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Pennsylvania billing rules 2026.06.15-current

Pennsylvania Medicaid doula billing rules

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

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Short answer

Pennsylvania 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

Pennsylvania Medicaid doula billing rules

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

Per-visit model

Prenatal visit (minimum 30 minutes): $100 with modifier U7

Postpartum visit (minimum 30 minutes): $100 with modifier U8

Other doula services/support (minimum 30 minutes): $175 with modifier U9

Labor and delivery support (in-person; delivery must occur): $1,000

What to check before billing

  • Enroll as a certified perinatal doula in MA (provider type 13, specialty 130); bill via PROMISe or MA MCOs.
  • T1032 must carry a pricing modifier: U7 prenatal, U8 postpartum, or U9 other services; each visit must be at least 30 minutes.
  • Keep the Doula Services Recommendation Form on file.
  • Initial prenatal visit and first postpartum visit must be in person; T1033 must be in person and is paid only when delivery occurs.
  • Combined prenatal + postpartum visits are limited to 12 per calendar year; other services limited to two; no prior authorization.

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

Pennsylvania is marked active. Check setup before claim work.

Launch status

active

Active: state tools are ready for general planning.

Billing portal

PROMISe (FFS); MA MCO pathways

  • Confirm PROMISe (FFS); MA MCO pathways access and provider enrollment before packet work.
  • Keep PROMISe provider ID / NPI in private records only.
  • Never enter Pennsylvania MA recipient 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 Pennsylvania denial reasons guide

Missing T1032 pricing modifier

Add the correct pricing modifier before submission.

Visit cap exceeded

Recount visits for the calendar year before billing.

Other-services cap exceeded

Confirm prior U9 usage before billing.

Visit under 30 minutes

Confirm documented time before billing.

Missing recommendation form

Obtain the recommendation form before billing.

Common questions

Plain answers about Pennsylvania Medicaid doula billing.

Does Pennsylvania Medicaid cover doula services?

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

How much does Pennsylvania Medicaid pay doulas?

Pennsylvania pays per visit — Prenatal visit (minimum 30 minutes): $100; Postpartum visit (minimum 30 minutes): $100; Other doula services/support (minimum 30 minutes): $175; Labor and delivery support (in-person; delivery must occur): $1,000. Use the Pennsylvania rate calculator to check current amounts against official sources.

What documentation does Pennsylvania require for doula claims?

Pennsylvania expects 5 visit-note items before a packet is ready, including: Enroll as a certified perinatal doula in MA (provider type 13, specialty 130); bill via PROMISe or MA MCOs. See the Pennsylvania visit-note checklist for the full list.

Why do Pennsylvania doula Medicaid claims get denied?

Common reasons include missing t1032 pricing modifier; visit cap exceeded; other-services cap exceeded. The Pennsylvania 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

Pennsylvania 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

PA MA Bulletin - Coverage of and Payment for Doula Services in the MA ProgramPennsylvania DHS / OMAP · Issued December 23, 2024; effective January 1, 2025; T1032 U7 $100, U8 $100, U9 $175, T1033 $1,000 · checked 2026-06-15PA Certification Board - Perinatal DoulaPennsylvania Certification Board · Certified perinatal doula requirement · checked 2026-06-15

Next steps

Use these Pennsylvania 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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