Summary
Already effective January 1, 2023: Michigan Medicaid covers doula services for dates of service on and after that date as preventive services under 42 C.F.R. Section 440.130(c). Covered visits are prenatal, labor and birth, and postpartum doula services, with a limit of six total prenatal and postpartum visits and one labor and delivery attendance visit per pregnancy. Doulas must complete training from an MDHHS-approved program, be certified by MDHHS, and register with the MDHHS Doula Registry to enroll as Medicaid providers.
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What to do
Action · 9 steps
01Already effective January 1, 2023: Billing team: Submit doula claims to the beneficiary's assigned Medicaid health plan (MHP) or, if the beneficiary is not enrolled in an MHP, submit fee-for-service claims through CHAMPS, using the pregnant or postpartum beneficiary's Medicaid ID number.
02Report prenatal and postpartum visits with procedure code S9445, modifier HD, and primary diagnosis Z33.1 (prenatal) or Z39.2 (postpartum), up to 6 total visits per pregnancy, at $75 per visit.
03Report labor and delivery attendance with procedure code T1033, modifier HD, and primary diagnosis Z33.1, for 1 visit at $700.
04Each prenatal and postpartum visit must be at least 20 minutes to be eligible for reimbursement.
05Doulas are encouraged to report Z55-Z65 social determinants of health codes such as Z56.1, Z59.1, or Z59.4.
06Document the start and end time of services, a description of the professional services, and the source of the licensed healthcare provider recommendation; records may be subject to review and post-payment audit.
07Visits beyond the policy limits require prior authorization, and MHP prior authorization requirements may differ from fee-for-service; contact the individual MHP for its requirements.
08FQHCs, RHCs, THCs, and Tribal FQHCs billing for doulas within the clinic must use the ASC X12N 837I institutional format with the clinic group NPI as billing provider, the attending provider NPI (a doula cannot be listed), and the enrolled doula's NPI as rendering provider.
09Clinics billing for doula services outside the clinic setting must bill separately on a CMS 1500/837P professional claim using their non-clinic Type 2 specialty NPI.
Codes mentioned
S9445T1033Z33.1Z39.2Z56.1Z59.1Z59.4
Original notice
MMP 22-47
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MMP 23-14: Updates to the MDHHS Medicaid Provider Manual; Medicaid Eligibility Requirements; Federal Public Health EmergencyMediumEffective Apr 1, 2023 · EnrollmentMMP 24-40: Update to Medicaid Coverage of Doula ServicesMediumEffective Oct 1, 2024 · Medical PolicyMMP 23-08: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesMediumEffective Jan 1, 2023 · Claims & BillingBrowse every Michigan Medicaid - MDHHS change in the policy list