杜拉服務常見問題
杜拉提供者-補償
衞生護理服務部（DHCS）涵蓋懷孕和產後個人的管理護理和服務費交付系統的杜拉服務。 服務包括對產前和產後檢查以及分產期間、流產和流產期間的非醫療支持。
1.Medi-Cal 支付竇拉拉多少服務費？(九月19,2025)
- 作為 Medi-Cal 目標費率調漲的一部分，自1 年 1 月起生效，2024 ，DHCS 將包括婦女陪護服務在內的 Medi-Cal 付費服務 (FFS) 費率調漲至全州聯邦醫療保險最低費率的 87.5%。請參閱「Doula 費率表」，以瞭解 2023 年費率與 2024 年費率的比較。
- 當前杜拉服務的服務費率如下：
- 初次訪問（90 分鐘）：$197.98
- 產前訪問：162.11 美元
- 產後訪問：$162.11
- 延長產後支持（三小時訪問）：$486.36
- 陰道分泌期間的支持：685.07 美元
- 腹產期間的支持：795.73 美元
- 流產期間或產後的支持：250.85 美元
- 流產期間或之後的支持：250.85 美元
2.什麼是 2024 年目標提供者費率調漲 (TRI)？(九月更新19,2025)
- 眾議院第 119 號法案（2023 年成文法第 13 章）授權徵收管理性看護組織 (MCO) 提供者稅，自 4 月1,2023, 至 12 月31,2026 。MCO 的稅收撥作特定用途，包括協助支付費率的增加及其他投資，以提高 Medi-Cal 會員的使用權、品質及公平性，並促進提供者（包括婦女輔導者）參與計畫。有關 TRI 的其他資訊，請造訪 DHCS TRI 網頁：Medi-Cal-Targeted-Provider-Rate- Increases。
- For a comparison of the 2023 rates to the TRI rates, please see the Doula Rates Chart.
3.我是否需要與管理性護理計劃 (MCP) 簽約，才能就提供給 MCP 會員的服務獲得 2024 TRI 費率？(九月更新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.杜拉服務的費率如何與支付給持牌醫護專業人員為產科服務的費率相符？
- 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.多拉服務的可計費代碼是什麼？
- 帳單代碼列在「Medi-Cal 提供者手冊：多拉服務」中。
6. 提交朵拉服務索賠時是否需要 「診斷代碼」？(2025年9月19日更新)
- 是的。無論是付費服務或管理性護理，都需要在補償單上註明診斷代碼，才能獲得補償。這是聯邦規定。由於竇拉拉不是醫療從業人員，也不診斷會員，DHCS 已經確定了竇拉拉可以使用的一般代碼，每個帳單代碼只需描述特定就診期間所發生的事情。
七.杜拉斯將如何從 DHCS 收取向 Medi-Cal 會員提供服務費的服務的付款？
- 為註冊服務費 Medi-Cal 的會員提供服務的註冊杜拉斯，將直接提交索償並向 Medi-Cal 賬單。 有關提交索償的信息可在 Doula-培訓和醫療服務提供商網頁上獲得。
八.杜拉斯將如何從 MCP 收到為會員提供的服務的付款？
- 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.
九.MCP 是否會向其合約的杜拉斯提供索償、帳單或發票培訓？
- 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.
十一.Medi-Cal 會否為流產、收養失敗、流產、死生、部分流失（雙胞胎 ／ 三胎等）懷孕，或必須留孩子在醫院/NICU 逗留等的情況下，Medi-Cal 會為喪親杜拉服務提供財政補償？
- 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.加州醫療保險管理性護理計劃（MCPs）需要很長的時間才能償付所提交的索賠要求。 我如何獲得有關提交索賠申請和帳單的協助？(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.
十三.我在哪裡可以獲得更多信息或提供反饋？
- 有關朵拉（doula）福利的資訊可在 DHCS 朵拉（doula）服務網頁上獲得。
- Please email DoulaBenefit@dhcs.ca.gov if you have additional questions.