Home Providers & Partners Doula Services Frequently Asked Questions

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 Medi-Cal members. 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?

For current rates, providers are encouraged to use the Medi-Cal Provider Manual Doula Services (doula) to locate applicable CPT and/or HCPCS codes for billing doula services. Those applicable codes can be used to look up the current fee-for-service rates on the Medi-Cal Rates | Medi-Cal Providers webpage.

2. What is the 2024 Targeted Provider Rate Increase (TRI)?

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?

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?

The billing codes are listed in the Medi-Cal Provider Manual: Doula Services.

6.  Is a “diagnosis code” required when submitting a claim for doula services?

Yes. Doulas need to include a diagnosis code on claims in both fee-for-service and 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?

Enrolled doulas who provide services to members enrolled in fee-for-service Medi-Cal will submit claims and bill Medi-Cal directly. Information about submitting claims is available on the Doula – Training and Medi-Cal Providers webpage.

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 resources. 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?

Initial provider dispute must be submitted directly to the applicable managed care plan. If providers receive an unsatisfactory provider dispute resolution response, they may file a complaint directly with the Department of Managed Health Care (DMHC) through the Provider Complaint Against a Plan web page.  File a complaint directly to DMHC at: How to File a Complaint 

11. Are doula services available for Medi-Cal reimbursement when provided to a member as part of an adoption pregnancy?

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?

The dispute resolution process can be used for claims disputes for both contracted and noncontracted providers.  Providers should submit a provider dispute resolution to the MCP if they submitted a clean claim that was not paid within 30 days of the claim submission. All MCPs are required by law to pay clean claims within 30 days of receipt.  If a MCP does not, then the MCP is required to pay interest on this claim in accordance with All Plan Letter 23-020 and H&S section 1371. 

If providers receive an unsatisfactory provider dispute resolution response from a Knox-Keene licensed plan, they may file a complaint directly with the Department of Managed Health Care (DMHC) through the Provider Complaint Against a Plan web page. File a complaint directly to DMHC at: How to File a Complaint