Doula Cov Kev Pab Cuam Tshuam Cov Lus Nug
Doula Cov Kws Pab Tswv Yim - Kev them nyiaj rov qab
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) suav nrog cov kev pabcuam doula hauv ob qho tib si tswj kev saib xyuas thiab them nqi-rau-kev pabcuam kev pabcuam rau cov menyuam cev xeeb tub thiab tomqab yug menyuam. Cov kev pabcuam muaj xws li kev pabcuam tsis yog khomob rau kev mus ntsib ua ntej yug menyuam thiab tomqab yug menyuam, thiab thaum lub sijhawm ua haujlwm thiab yug menyuam, nchuav menyuam, thiab rho menyuam tawm.
1. Puas yog Medi-Cal them ob npaug rau lawv cov kev pabcuam? (September 19, 2025)
- Raws li ib feem ntawm Medi-Cal Targeted Rate Ntxiv rau Lub Ib Hlis Ntuj 1, 2024, DHCS tau nce Medi-Cal tus nqi-rau-kev pabcuam (FFS) rau cov kev pabcuam niam txiv, suav nrog cov kev pabcuam doula, mus rau 87.5 feem pua ntawm cov nqi qis tshaj hauv xeev Medicare. Thov saib Doula Rates Chart rau kev sib piv ntawm 2023 tus nqi rau 2024 tus nqi.
- Tam sim no tus nqi-rau-kev pabcuam rau cov kev pabcuam doula yog raws li hauv qab no:
- Thawj zaug mus ntsib (90 feeb): $197.98
- Kev mus ntsib niam txiv: $162.11
- Kev mus ntsib tom qab yug menyuam: $162.11
- Ntxiv kev txhawb nqa tom qab yug menyuam (rau kev mus ntsib peb-teev): $486.36
- Kev them nyiaj yug thaum lub caij yug me nyuam: $685.07
- Kev them nyiaj yug thaum lub sij hawm caesarian: $795.73
- Kev them nyiaj yug thaum lub sij hawm los yog tom qab nchuav menyuam: $ 250.85
- Kev them nyiaj yug thaum lub sij hawm los yog tom qab rho menyuam: $250.85
2. Dab tsi yog 2024 Targeted Provider Rate Nce (TRI)? (hloov kho lub Cuaj Hlis 19, 2025)
- Assembly Bill 119 (Chapter 13, Statutes of 2023) tau tso cai rau lub koom haum saib xyuas kev tswj hwm (MCO) cov se, pib lub Plaub Hlis 1, 2023, txog rau lub Kaum Ob Hlis 31, 2026. Cov nyiaj tau los ntawm MCO tau tsim nyog rau cov hom phiaj tshwj xeeb suav nrog kev pab them nqi nce nqi thiab lwm yam kev nqis peev uas ua rau kev nkag mus tau zoo, kev ua tau zoo, thiab kev ncaj ncees rau Medi-Cal cov tswv cuab thiab txhawb nqa kev koom tes hauv qhov kev pab cuam, suav nrog doulas. Yog xav paub ntxiv txog TRI, thov mus saib hauv DHCS TRI lub vev xaib: Medi-Cal-Targeted-Provider-Rate- Nce.
- For a comparison of the 2023 rates to the TRI rates, please see the Doula Rates Chart.
3. Kuv puas yuav tsum tau cog lus nrog txoj kev npaj khomob (MCP) kom tau txais 2024 TRI tus nqi rau kev pabcuam rau cov tswvcuab MCP? (hloov kho lub Cuaj Hlis 19, 2025)
- Yes. These rates apply to services provided on or after January 1, 2024, for providers who are contracted with a MCP. DHCS issued All Plan Letter 24-007 to provide guidance to the plans about the TRI and that they needed to attest by December 31, 2024, that they paid all eligible network providers the 2024 TRI rates for qualifying services. MCPs only pay the TRI to eligible network providers with whom they have a contract or an unbroken chain of contracts between the provider and the MCP. MCPs are not required to pay the TRI to providers when they are working under Letter of Agreement or a one-time agreement.
4. Yuav ua li cas cov nqi rau cov kev pab cuam doula ua raws li cov nqi them rau cov kws kho mob uas muaj ntawv tso cai rau kev pab niam txiv?
- Doulas use the same billing codes and are paid the same rate as physicians, nurse practitioners, and midwives for the initial visit, prenatal visits, postpartum visits, abortion, and for labor and delivery. Doulas need to use modifier XP when billing for services provided to fee-for-service and Medi-Cal MCP members. XP notes that the service was provided by a doula instead of a licensed practitioner.
5. Dab tsi yog cov lej them nqi rau cov kev pabcuam doula?
- Cov lej sau nqi tau teev nyob rau hauv Medi-Cal Tus Kws Kho Mob Phau Ntawv Qhia: Doula Services.
6. Puas yog "kev kuaj mob code" xav tau thaum xa daim ntawv thov rau cov kev pabcuam doula? (Hloov kho lub Cuaj Hlis 19, 2025)
- Yog lawm. Doulas yuav tsum suav nrog tus lej kuaj mob ntawm kev thov hauv ob qho tib si tus nqi-rau-kev pabcuam lossis kev saib xyuas kev tswj hwm thiaj li yuav tau them. Qhov no yog ib qho tseem ceeb ntawm tsoom fwv. Txij li thaum doulas tsis yog kws kho mob thiab tsis kuaj cov tswv cuab, DHCS tau txheeb xyuas cov lej dav dav uas doulas yuav siv tau rau txhua tus lej lej, uas yooj yim piav qhia txog dab tsi tshwm sim thaum mus ntsib.
7. Doulas yuav tau txais kev them nqi li cas los ntawm DHCS rau cov kev pab cuam muab rau cov tswv cuab Medi-Cal nrog tus nqi-rau-kev pabcuam?
- Cov menyuam kawm ntawv doulas uas muab kev pabcuam rau cov tswvcuab uas sau npe rau hauv tus nqi-rau-kev pabcuam Medi-Cal yuav xa cov ntaub ntawv thov thiab sau nqi Medi-Cal ncaj qha. Cov ntaub ntawv hais txog kev xa cov ntaub ntawv thov muaj nyob rau ntawm Doula – Training and Medi-Cal Providers webpage.
8. Doulas yuav tau txais kev them nyiaj los ntawm MCPs li cas rau cov kev pabcuam muab rau lawv cov tswvcuab?
- Doulas who provide services to Medi-Cal MCP members must enter into contracts with MCPs to receive reimbursement for services provided to MCP members. Doulas must follow the claims and reimbursement processes for the MCPs with whom they are contracted.
9. MCPs puas yuav muab kev thov, kev them nqi, lossis kev qhia them nqi rau lawv daim ntawv cog lus Doulas?
- Doulas should contact the MCPs that are contracted with for specific claims, billings, or invoice training. MCPs must provide direct instruction, training, and technical assistance to its providers to support information transmission and the submission of Clean Claims, including bills or invoices submitted by doulas that are unable to submit claims through an electronic file format.
10. What resources are available for doulas who are dealing with a denied claim or timeliness for claims reimbursement? (Updated September 19, 2025)
- DHCS has created a helpful resource to assist doulas with navigating issues involving denied claims or timeliness of payments. Please see the FAQ for Dispute Resolution Process.
11. Puas yog Medi-Cal puas yuav faib nyiaj them rau cov kev pab cuam doula thaum nchuav menyuam, kev yug menyuam ua tsis tiav, rho menyuam tawm, tseem yug menyuam, poob ib nrab (ntxaib / triplet, thiab lwm yam) cev xeeb tub, lossis cov niam txiv uas yuav tsum tso lawv tus menyuam hauv tsev khomob / NICU nyob, thiab lwm yam?
- Doula services pertaining to cases of miscarriage, stillbirth or abortion, including postpartum visits are covered and billable services. Please refer to the Medi-Cal Provider Manual: Doula Services for information om the appropriate procedure codes to use. Doula services pertaining to adoptions are not covered.
12. Medi-Cal cov phiaj xwm tswj hwm kev saib xyuas (MCPs) tau siv sijhawm ntev los them rov qab rau cov ntaub ntawv xa tuaj. Kuv tuaj yeem tau txais kev pab cuam li cas txog kev xa ntawv thov thiab kev them nqi? (Hloov kho lub Cuaj Hlis 19, 2025)
- MCPs must pay for “clean claims” within the timeframes specified in All Plan Letter 23-020. A “clean claim” is a claim that does not need to be returned to the provider for corrections or additional information in order to be paid. If you have questions and would like to speak to an individual with a MCP for assistance, please email DoulaBenefit@dhcs.ca.gov and include the name of the MCP and the topic of your question(s). DHCS will follow up with the name and contact information for the MCP.
13. Kuv tuaj yeem tau txais cov ntaub ntawv ntxiv los yog muab cov lus qhia nyob qhov twg?
- Cov ntaub ntawv hais txog qhov txiaj ntsig doula muaj nyob rau ntawm DHCS Doula Services lub vev xaib.
- Please email DoulaBenefit@dhcs.ca.gov if you have additional questions.