Medi-Cal FFS Doula Billing Codes Chart
Cov nqi no teev hauv qab no qhia txog cov nqi uas tau them rau xyoo 2023 ua ntej thiab cov nqi uas tau them tom qab kev siv ntawm 2024 Targeted Rate Increases (TRI) rau cov kev pabcuam uas tau muab rau lossis tom qab Lub Ib Hlis 1, 2024. Yog xav paub ntxiv txog thaum twg cov kev pabcuam tsim nyog rau TRI, thov saib Cov Lus Nug Nquag Nug rau Kev Them Nyiaj Rov Qab.
Daim duab 1
| Cov lej nyiaj | Cov kev pab cuam | Non-TRI Doula Rate (Per Visit) | Current TRI Doula Rate+ (Per Visit) |
|---|---|---|---|
| HCPCS Code Z1032 | Extended Initial Visit, 90 feeb | $ 126.31 | $ 197.98 |
| HCPCS Code Z1034 | Prenatal lossis postpartum mus ntsib (txog 8 mus ntsib) | $ 60.48 | $ 162.11 |
| CPT Code 59409* | Kev them nyiaj yug thaum lub caij yug me nyuam | $ 544.72 | $ 685.07 |
| CPT Code 59612* | Kev them nyiaj yug thaum lub sij hawm me nyuam hauv qhov chaw mos tom qab kev phais tas los | $ 544.72 | $ 768.69 |
| CPT Code 59620* | Txhawb nqa thaum lub sij hawm caesarean | $ 544.72 | $ 795.73 |
| HCPCS Code T1033* | Txhawb nqa thaum lub sij hawm los yog tom qab nchuav menyuam | $250.85 | $250.85 |
| CPT Code 59840* | Kev them nyiaj yug thaum lub sij hawm los yog tom qab rho menyuam | $250.85 | $250.85 |
| HCPCS Code T1032 | Txuas ntxiv mus xyuas tom qab yug me nyuam (txog 2 mus ntsib) | $180.00 | $ 486.36 |
| HCPCS code Z1038** | Kev mus ntsib tom qab yug menyuam ntxiv (txog 9 mus ntsib) | $ 60.48 | $ 162.11 |
+As of January 1, 2024 as part of the Department’s Targeted Rate Increase. For more information, please see Medi-Cal-Targeted-Provider-Rate-Increases.
* Tsuas yog ib qho ntawm cov lej no yuav raug them nqi, raws li qhov tsim nyog.
** Yuav tsum tau pom zoo thib ob rau daim nqi.
Medi-Cal FFS Piv txwv ntawm cov nyiaj them rov qab ntau tshaj
The chart below provides Medi-Cal FFS examples of the maximum reimbursement amount for the TRI per pregnancy for doulas as of January 1, 2024. The maximum amount reflects the total number of services that may be provided with the standing recommendation.
The second recommendation for additional postpartum services would allow a doula to receive an additional $1,458.99, on top of the amounts in Figure 1 if they provided all nine postpartum visits.
Daim duab 2
| Kev piav qhia ntawm Kev Pabcuam Xa | Yav dhau los Cov nyiaj them rov qab siab tshaj plaws | Cov nyiaj them rov qab siab tshaj tam sim no |
|---|---|---|
| Txhua qhov kev pom zoo thawj zaug mus ntsib thiab txhawb nqa thaum lub caij yug me nyuam | $ 1,514.87 | $ 3,152.65 |
| Txhua qhov kev pom zoo thawj zaug mus ntsib thiab txhawb nqa thaum lub caij yug me nyuam tom qab kev phais tas los | $ 1,514.87 | $ 3,236.27 |
| Txhua qhov kev pom zoo pib mus ntsib thiab txhawb nqa thaum lub sij hawm caesarean | $ 1,514.87 | $ 3,263.31 |