MedicaidBilling CodesHigh impact
[Ohio] OH Medicaid Doula claim submission FAQ
Anthem BCBS·OH · OB-GYN·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 27, 2026
Summary
Ohio Medicaid has established a comprehensive FAQ for doula service claim submission effective April 1, 2026. Claims must be submitted electronically via EDI through an approved trading partner or via Availity Essentials Direct Data Entry; paper claims are no longer accepted. Billing teams must use specific HCPCS codes (T1032, T1033, T1023) with designated diagnosis codes (Z32.2, Z32.3) and append the GT modifier for telehealth services.
Action Required
By April 1, 2026: Billing team must implement the following changes: (1) Update billing software to reject all paper doula claims and require electronic submission only via EDI or Availity Essentials DDE; (2) Configure system to enforce use of HCPCS codes T1032 (prenatal/postpartum services, $12.50 per 15-minute unit, maximum $600), T1033 (delivery services, $600 flat rate), and T1023 (Report of Pregnancy, $30.00); (3) Update claim validation rules to require diagnosis code Z32.2 for all prenatal/delivery visits and Z32.3 for all postpartum visits in Box 21 of the CMS-1500 form; (4) Append GT modifier for all telehealth doula services submitted under T1032; (5) Ensure all claims are submitted to ODM's Fiscal Intermediary with Anthem payer ID 0002937; (6) Train billing staff on Availity Essentials registration and DDE submission process via the care provider learning hub (on24.com); (7) Confirm all doulas have registered accounts on Availity Essentials at https://Availity.com. Failure to comply will result in claim denials and delays in reimbursement. Set timely filing deadline reminder for 365 days from date of service.