MedicaidCoverageMedium impact
Newsletter Vol. 31, No.04
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, General Practice·Coding
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers doula services effective January 1, 2021. Doulas must enroll as individual Medicaid/FFS providers and can bill for prenatal, delivery, and postpartum support using six new HIPAA-compliant codes. Standard care includes 8 prenatal/postpartum visits plus 1 delivery; enhanced care (ages 19 and under) includes 12 visits plus 1 delivery. A clinician recommendation is required prior to initiating doula care.
Action Required
Effective January 1, 2021: Billing team must add six new doula service billing codes to the system (99600 HD U7, 99600 HD, 99600 HD 22, 59409 HD, 59514 HD, 99199 HD, 99199 HD U8, 99199 HD 22) with corresponding maximum reimbursement rates and unit limits. Update encounter forms and workflows to: (1) require a clinician recommendation before doula services are initiated, (2) verify patient eligibility (pregnant, birthing, or postpartum individuals in NJFC plans ABP, A, B, C, D—excluding NJSPCP), (3) apply visit limits of 8-1 (standard) or 12-1 (enhanced for ages 19 and under) per doula-member pair, and (4) flag that multiple same-day visits are only allowed in specific L&D scenarios. Credentialing staff must establish a process to verify that doula providers are enrolled with Gainwell Technologies (609-588-6036) as FFS providers before claims are accepted. Managed care staff should verify MCO enrollment separately with each plan. Failure to implement proper visit tracking and clinician recommendations will result in claim denials.