Washington billing rules 2025.10.01-current
Washington Medicaid doula billing rules
Check Washington 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
Washington Medicaid doula billing rules
Washington uses 15-minute billing units at $25, with a 80-unit / $3,500 cap and service-line rules to check before claim entry.
Recently updated
Updated Jun 10, 2026Official fee scheduleRates are backed by official published fee-schedule or rate evidence in the source packet.
- Checked Washington State Health Care Authority: Washington HCA Birth Doula Services Billing Guide.
- Checked Washington State Health Care Authority: Washington HCA Birth Doula Services Fee Schedule.
How payment works
Verified Jun 17, 2026$25 per 15-minute unit, with a limit of 80 units and $3,500 per client.
What to check before billing
- Document the date, duration, nature of care, coordination with medical or community resources, and referrals.
- Preserve enough detail to support every billed service line.
- Verify client Apple Health eligibility before claim review.
- Track the 20-hour / 80-unit prenatal and postpartum visit limit, including 6 units designated for postpartum care.
- Document in-person prerequisites before billing later telemedicine visits; audio-only telemedicine is not covered.
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
ProviderOne
- Confirm ProviderOne access and provider enrollment before first-claim work.
- Keep ProviderOne provider ID in your own secure records.
- Keep Apple Health client ID, names, dates of birth, and visit notes out of public pages.
Washington rate details
Use the official HCA billing guide and fee schedule as the source of truth before preparing a real claim.
Prenatal intake visit
- How billed
- Flat payment
- Rate
- $750
- Notes
- Billed once when billing rules are met.
Labor and delivery support
- How billed
- Flat payment
- Rate
- $750
- Notes
- Billed once when billing rules are met.
Additional prenatal and postpartum visits
- How billed
- 15-minute units
- Rate
- $25
- Notes
- Part of the 80-unit limit.
| Service type | How it is billed | Rate | Notes |
|---|---|---|---|
| Prenatal intake visit | Flat payment | $750 | Billed once when billing rules are met. |
| Labor and delivery support | Flat payment | $750 | Billed once when billing rules are met. |
| Additional prenatal and postpartum visits | 15-minute units | $25 | Part of the 80-unit limit. |
Limit and timing reminder
Washington uses $25 per 15-minute unit for additional prenatal and postpartum visits, with a limit of 80 units / $3,500 per client.
Additional prenatal and postpartum visits should be counted before billing review, especially when a client has multiple prenatal and postpartum visits.
Services Washington does not cover
These exclusions come from WAC 182-533-0665 and are common sources of billing confusion.
Childcare
WAC 182-533-0665Chore services, including shopping and cooking
WAC 182-533-0665Group services
WAC 182-533-0665Phone calls, text messages, and emails
WAC 182-533-0665Note-writing time
WAC 182-533-0665Travel time and mileage
WAC 182-533-0665Example Washington claim check
This example is for planning only. Actual billing depends on the current HCA billing guide, service details, modifiers, visit notes, and payer review.
Visit 1
Prenatal intake visit
- Duration
- Flat
- Units
- 1 line
- Estimated reimbursement
- $750
Visit 2
Additional prenatal visit
- Duration
- 60 min
- Units
- 4 units
- Estimated reimbursement
- $100
Visit 3
Additional prenatal visit
- Duration
- 45 min
- Units
- 3 units
- Estimated reimbursement
- $75
Birth
Labor and delivery support
- Duration
- Flat
- Units
- 1 line
- Estimated reimbursement
- $750
Visit 4
Postpartum visit
- Duration
- 45 min
- Units
- 3 units
- Estimated reimbursement
- $75
Visit 5
Comprehensive postpartum visit
- Duration
- 60 min
- Units
- 4 units
- Estimated reimbursement
- $100
| Visit | Service type | Duration | Units | Estimated reimbursement |
|---|---|---|---|---|
| Visit 1 | Prenatal intake visit | Flat | 1 line | $750 |
| Visit 2 | Additional prenatal visit | 60 min | 4 units | $100 |
| Visit 3 | Additional prenatal visit | 45 min | 3 units | $75 |
| Birth | Labor and delivery support | Flat | 1 line | $750 |
| Visit 4 | Postpartum visit | 45 min | 3 units | $75 |
| Visit 5 | Comprehensive postpartum visit | 60 min | 4 units | $100 |
| Planning total | 14 timed units plus flat lines | $1,850 | ||
For each visit, keep the date, duration, nature of care, coordination, and referral details in your own secure records. Use the Washington claim checker before entering a claim into ProviderOne.
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 Washington services before claim entry. Do not enter client names, IDs, dates of birth, or visit notes here.
Estimated total
$1,525.00
This estimate is checked against a $3,500.00 state cap.
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.
Missing Apple Health client ID
Verify eligibility and enter the Apple Health client ID before submission.
Units exceed state limit
Recalculate timed visits and document whether a limitation extension is needed.
Documentation does not support service
Add visit documentation before exporting the packet.
Telemedicine service is not payable
Confirm an in-person qualifying visit is documented or change the service line before submission.
Timely filing window risk
Check service dates and prioritize packets near the 365-day filing limit.
Overnight postpartum support is not covered
Remove noncovered services or document a covered doula service instead.
Common questions
Plain answers about Washington Medicaid doula billing.
Does Washington Medicaid cover doula services?
Yes. Apple Health birth doula services covers doula services. Coverage still depends on active eligibility, the service date, provider setup, and visit notes.
How much does Washington Medicaid pay doulas?
Washington pays by time block: $25 per 15-minute unit, up to 80 units ($3,500) per client. Use the Washington rate reference to check current amounts against official sources.
What should my Washington visit note include?
Washington lists 5 visit-note checks to review before claim entry, starting with: Document the date, duration, nature of care, coordination with medical or community resources, and referrals.. See the Washington visit-note checklist for the full list.
Why do Washington doula Medicaid claims get denied?
Common reasons include missing apple health client id; units exceed state limit; documentation does not support service. The Washington denied-claim guide lists the next step for each.
Can a Washington doula bill for phone calls, texts, or emails?
No. WAC 182-533-0665 lists phone calls, text messages, and emails as noncovered birth doula services.
Can a Washington doula bill for travel time or mileage?
No. WAC 182-533-0665 excludes travel time and mileage. Only covered doula service time should be used for billing decisions.
Can a Washington doula bill for note-writing time?
No. WAC 182-533-0665 excludes note-writing time. Keep visit notes complete, but do not count that time as a covered doula service.
Does Washington pay fee-for-service for managed care clients?
Yes. WAC 182-533-0670 says Apple Health pays covered birth doula services through fee-for-service using the agency fee schedule for eligible managed care and fee-for-service clients.
Can Washington birth doula services be provided by telemedicine?
Some services can be audio-visual telemedicine only after the in-person prerequisites in WAC 182-533-0680 are met. Prenatal intake, labor and delivery support, and specified first visits are not payable by telemedicine.
What happens if a Washington claim exceeds the unit cap?
If units are over the published limit, pause and check whether authorization or an exception path applies before billing. Track cumulative units before claim entry.
Can Washington doulas bill group services?
No. WAC 182-533-0665 lists group services as noncovered for birth doulas.
What should each Washington doula visit note include?
Document the service date, duration, nature of care, coordination with medical or community resources, and referrals. Keep client-specific notes in your own secure records.
Rule change alerts
Get a no-PHI email when Washington 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 currentWashington 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.