Pennsylvania billing rules 2026.06.15-current
Pennsylvania Medicaid doula billing rules
Check Pennsylvania 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
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Pennsylvania Medicaid doula billing rules
Pennsylvania uses per-visit service lines such as Prenatal visit (minimum 30 minutes) at $100, with modifiers, caps, and documentation checks to confirm before claim entry.
Recently updated
Updated Jun 15, 2026Official source packetCoverage and billing rules are tied to official state or payer sources.
- Checked Pennsylvania DHS / OMAP: PA MA Bulletin - Coverage of and Payment for Doula Services in the MA Program.
- Checked Pennsylvania Certification Board: PA Certification Board - Perinatal Doula.
Paid by visit
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.
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
PROMISe (FFS); MA MCO pathways
- Confirm PROMISe (FFS); MA MCO pathways access and provider enrollment before first-claim work.
- Keep PROMISe provider ID / NPI in your own secure records.
- Keep Pennsylvania MA recipient 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 Pennsylvania services before claim entry. Do not enter client names, IDs, dates of birth, or visit notes here.
Estimated total
$1,375.00
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.
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 active eligibility, the service date, provider setup, and visit notes.
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 reference to check current amounts against official sources.
What should my Pennsylvania visit note include?
Pennsylvania lists 5 visit-note checks to review before claim entry, starting with: 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.
Rule change alerts
Get a no-PHI email when Pennsylvania 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 currentPennsylvania 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.