Doula Services Frequently Asked Questions
Doula Providers- Reimbursement
The Department of Health Care Services (DHCS) covers doula services in both managed care and fee-for-service delivery systems for pregnant and postpartum individuals. Services include nonmedical support for prenatal and postpartum visits, and during labor and delivery, miscarriage, and abortion.
1. How much does Medi-Cal pay doulas for their services? (September 19, 2025)
- As part of the Medi-Cal Targeted Rate Increases effective January 1, 2024, DHCS increased Medi-Cal fee-for-service (FFS) rates for maternal care services, including doula services, to 87.5 percent of the lowest statewide Medicare rate. Please see the Doula Rates Chart for a comparison of the 2023 rates to the 2024 rates.
- The current fee-for-service rates for doula services are as follows:
- Initial visit (90 minutes): $197.98
- Prenatal visit: $162.11
- Postpartum visit: $162.11
- Extended postpartum support (for a three-hour visit): $486.36
- Support during vaginal delivery: $685.07
- Support during caesarian section: $795.73
- Support during or after miscarriage: $250.85
- Support during or after abortion: $250.85
2. What is the 2024 Targeted Provider Rate Increase (TRI)? (updated September 19, 2025)
- Assembly Bill 119 (Chapter 13, Statutes of 2023) authorized a managed care organization (MCO) provider tax, effective April 1, 2023, through December 31, 2026. MCO tax revenues are appropriated for specific purposes including helping pay for rate increases and other investments that advance access, quality, and equity for Medi-Cal members and promote provider participation in the program, including doulas. For additional information regarding the TRI, please visit the DHCS TRI webpage: Medi-Cal-Targeted-Provider-Rate- Increases.
- For a comparison of the 2023 rates to the TRI rates, please see the Doula Rates Chart.
3. Do I need to be contracted with the managed care plan (MCP) to receive the 2024 TRI rates for services provided to MCP members? (updated September 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. How do rates for doula services align with rates paid to licensed health care professionals for maternity services?
- 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. What are the billable codes for doula services?
6. Is a “diagnosis code” required when submitting a claim for doula services? (Updated September 19, 2025)
- Yes. Doulas need to include a diagnosis code on claims in both fee-for-service or managed care in order to be paid. This is a federal requirement. Since doulas are not medical practitioners and do not diagnosis members, DHCS has identified general codes that doulas may use for each billing code, which simply describes what occurred during a particular visit.
7. How will doulas receive payment from DHCS for services provided to Medi-Cal members with fee-for-service?
8. How will doulas receive payment from MCPs for services provided to their members?
- 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. Will MCPs provide claiming, billing, or invoice training to their contracted 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. Will Medi-Cal allocate financial compensation for bereavement doula services in cases of miscarriage, failed adoptions, abortions, still-born, partial loss (twin/triplet, etc.) pregnancy, or parents who must leave their child at the hospital / NICU stays, etc.?
- 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 managed care plans (MCPs) are taking a long time to reimburse for submitted claims. How can I get assistance regarding claims submission and billing? (updated September 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. Where can I get more information or provide feedback?
- Information about the doula benefit is available on the DHCS Doula Services webpage.
- Please email DoulaBenefit@dhcs.ca.gov if you have additional questions.
