导乐服务常见问题
助产师 - 报销
卫生保健服务部 (DHCS) 为孕妇和产后人员提供管理式护理和按服务收费的分娩陪护服务。 服务包括产前和产后访问以及分娩、流产和堕胎期间的非医疗支持。
1.Medi-Cal 支付给朵拉多少服务费？(September19,2025)
- 作为 Medi-Cal 目标费率增长的一部分，自1 年 1 月起生效，2024 ，DHCS 将产妇护理服务（包括陪护服务）的 Medi-Cal 付费服务（FFS）费率提高到全州医疗保险最低费率的 87.5%。请参阅 "杜拉费率表"，了解 2023 年费率与 2024 年费率的比较。
- 目前助产师服务的收费标准如下：
- 初次就诊（90分钟）：197.98 美元
- 产前检查：162.11 美元
- 产后访视：162.11 美元
- 延长产后支持（三小时访问）：486.36 美元
- 阴道分娩期间的支持：685.07 美元
- 剖腹产期间的支持：795.73 美元
- 流产期间或流产后的支持：250.85 美元
- 堕胎期间或之后的支持：250.85 美元
2.什么是 2024 年目标医疗保险费率增长（TRI）？(9月更新19,2025)
- 众议院第 119 号法案（2023 年法规第 13 章）授权征收管理性医疗组织 (MCO) 提供者税，从 4 月1,2023, 到 12 月31,2026 。MCO 税收被分配用于特定用途，包括帮助支付费率增长和其他投资，以提高 Medi-Cal 成员的可及性、质量和公平性，并促进医疗服务提供者（包括助产士）参与该计划。有关 TRI 的更多信息，请访问 DHCS TRI 网页：Medi-Cal-Targeted-Provider-Rate- Increases.
- For a comparison of the 2023 rates to the TRI rates, please see the Doula Rates Chart.
3.我是否需要与管理性保健计划（MCP）签订合同，才能获得为 MCP 会员提供服务的 2024 年 TRI 费率？(9月更新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. 助产师服务的收费与持照保健专业人员的产科服务收费如何一致？
- 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. 助产师服务的计费代码是什么？
- 账单代码列于Medi-Cal 提供商手册：Doula 服务中。
6. 提交朵拉服务索赔时是否需要 "诊断代码"？(2025年9月19日更新)
- 是的。无论是付费服务还是管理式医疗，都需要在杜拉拉的报销单上注明诊断代码才能获得支付。这是一项联邦要求。由于朵拉不是执业医师，也不对成员进行诊断，DHCS 已确定了朵拉可用于每个计费代码的通用代码，这些代码仅描述特定就诊期间发生的情况。
7. 助产士如何从 DHCS 获得为 Medi-Cal 会员提供收费服务的报酬？
- 为参加收费 Medi-Cal 计划的会员提供服务的注册助产士将提交索赔并直接向 Medi-Cal 收费。 关于提交索赔的信息可在Doula - 培训和 Medi-Cal 提供商网页上找到。
8. 助产士如何从 MCP 处获得为其会员提供服务的报酬？
- 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. MCP 会为其签约的 Doulas 提供索赔、账单或发票培训吗？
- 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. 在发生流产、收养失败、堕胎、死产、部分流产（双胞胎/三胞胎等）或父母必须将孩子留在医院/新生儿重症监护室等情况下，Medi-Cal 是否会为丧亲陪护服务提供经济补偿？
- 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.加州医疗保险管理性护理计划（MCP）需要很长时间才能报销所提交的报销申请。 如何获得有关提交报销申请和账单的帮助？（2025 年 9 月 19 日更新）
- 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.我可以在哪里获取更多信息或提供反馈？
- 有关朵拉福利的信息请访问 DHCS 朵拉服务网页。
- Please email DoulaBenefit@dhcs.ca.gov if you have additional questions.