Medi-Cal FFS Doula Billing Codes Chart
These rates listed below display the rates paid in 2023 prior and the rates paid after implementation of the 2024 Targeted Rate Increases (TRI) for services provided on or after January 1, 2024. For more information about when services are eligible for the TRI, please see the Frequently Asked Questions for Reimbursement.
Figure 1
| Billing Codes | Covered Services | Non-TRI Doula Rate (Per Visit) | Current TRI 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.
Medi-Cal FFS Examples of Maximum Reimbursement Calculations
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.
Figure 2
| 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 |