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? (Added August 16, 2024)
- 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 figure 1 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 March 14, 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.
3. When can I expect to receive the new 2024 rates? (updated March 14, 2025)
- These rates apply to services provided on or after January 1, 2024, for providers who are contracted with a managed care plan (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. The TRI is not available to providers when they are working under Letter of Agreement or a one-time agreement. MCPs were required to retroactively adjust payments for services previously provided by network providers back to January 1, 2024. As of this update, 19 of 24 MCPs have attested their compliance. DHCS continues to work with the five remaining MCPs to bring them into compliance.
Figure 1 – Medi-Cal FFS Billing Code Chart – Initial Recommendation
In the Medi-Cal FFS delivery system, DHCS implemented the TRI in January 2024 and reimburses doulas at the same rates as it pays licensed providers for maternal care, as outlined in the chart, below with an initial
recommendation. (See question #4 for services that the initial recommendation authorizes.)
Billing Codes
| Covered Services
| Previous Doula Rate (Per Visit)
| Current Doula Rate+ (Per Visit)
|
HCPCS Code Z1032
| Extended Initial Visit, 90 minutes
| $126.31
| $197.98
|
HCPCS Code Z1034
| Prenatal or postpartum visits (up to 8 visits)
| $60.48
| $162.11
|
CPT Code 59409*
| Support during vaginal delivery
| $544.72
| $685.07
|
CPT Code 59612*
| Support during vaginal delivery after previous caesarean section
| $544.72
| $768.69
|
CPT Code 59620*
| Support during caesarean section
| $544.72
| $795.73
|
HCPCS Code T1033*
| Support during or after miscarriage
| $250.85
| $250.85
|
CPT Code 59840*
| Support during or after abortion
| $250.85
| $250.85
|
HCPCS Code T1032
| Extended postpartum visits (up to 2 visits)
| $180.00
| $486.36
|
HCPCS code Z1038**
| Additional postpartum visits (up to 9 visits)
| $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.
*Only one of these codes would be billed, as appropriate.
**Requires a second recommendation to bill.
Figure 2 – Medi-Cal FFS Examples of Maximum Reimbursement Calculations(See question #4 for information regarding the second recommendation)
The chart below provides Medi-Cal FFS examples of the maximum per pregnancy reimbursement amounts for doulas as of January 1, 2024, which reflects the total number of services that may be provided with the initial recommendation.
The second recommendation would allow a doula to receive an additional $1,458.99, on top of the amounts in the chart below if they provided all nine postpartum visits.
Description of Services Delivered
| Previous Maximum Reimbursement Amount
| Current Maximum Reimbursement Amount
|
All initial recommendation visits and support during vaginal delivery
| $1,514.87
| $3,152.65
|
All initial recommendation visits and support during vaginal delivery after previous caesarean section
| $1,514.87
| $3,236.27
|
All initial recommendation visits and support during caesarean section
| $1,514.87
| $3,263.31
|
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4. How do rates for doula services align with rates paid to licensed health care professionals for maternity services?
- Doulas use the same 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 March 14, 2025)
- Yes. Starting November 1, 2024, claims for doula services will require a diagnosis code, 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 that simply describes what occurred during a particular visit. The list of diagnosis codes for each billing code is available in the Medi-Cal Provider Manual: Doula Services.
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. Please see Managed Care Plan Contact List for names and contact information for each plan.
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? (added March 14,2025)
- MCPs must have a Provider Dispute Resolution Mechanism that includes timely, fair, and cost-effective dispute resolution process where Network Providers can submit disputes. Providers may submit a dispute to MCPs regarding: 1) The authorization or denial of a service; 2) The processing of a payment or non-payment of a claim by MCP; or 3) The timeliness of the reimbursement on an uncontested Clean Claim and any interest MCP is required to pay on claims reimbursement per APL-23-020.
- If a doula has already initiated this process and continue to face challenges, they can reach out to DHCS for further assistance via email at DoulaBenefit@dhcs.ca.gov. Doulas must provide enough detailed information to enable DHCS to effectively follow up with the MCP. Please include information, such as: Doula Name; Doula NPI; Name of the MCP(s) that you are having challenges with; Brief description of the issue. Please include date(s), claim number(s), confirmation/reference number(s), outstanding balance and age of claims associated with the issue; when did the Doula initiate the MCP's provider dispute process? What specific responses has the doula received from the MCP(s) via the provider dispute process?; and name of any MCP representatives that you spoke to regarding the issue.
- Please include the MCP's email or phone number you used to contact the plan; doula contact information for follow-up (email and/or phone number preferred). DO NOT include protected health information (PHI) for the member unless requested by the plan and shared securely.
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 the proper procedure codes. Doula services regarding 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 March 14, 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. For additional assistance, please contact the MCP coordinator listed on the Managed Care Plan Contact List.
13. Where can I get more information or provide feedback?
- Information about the doula benefit and stakeholder meetings is available on the DHCS Doula Services webpage.
- Please email DoulaBenefit@dhcs.ca.gov with any further feedback, questions, and comments.
