Coverage of Doula Services for HealthChoice and Medicaid Fee-For-Service Enrollees

REQUIREMENTS: By immediately (June 27, 2024 or upon receipt): Billing team and claims processing staff must: 1. Update billing software to recognize and process HCPCS codes T1032 and T1033 for Maryland Medicaid HealthChoice MCO and fee-for-service claims 2. Configure billing rules in your system for T1032 (prenatal/postpartum visits): - Rate: $16.62 per 15-minute unit - Maximum 4 units per service; 8 units maximum total - Place of Service codes: 04/12 (home), 11/50/22 (doctor's office), 11/99 (community), or 02/12 (telehealth) - Use GT modifier for telehealth claims only - Postpartum claims use T1032 with U9 modifier at $19.62 per unit 3. Configure billing rules for T1033 (delivery attendance): - Rate: $800 flat fee per delivery - Place of Service codes: 21/25 (hospital or birthing center in-person only) - No telehealth allowed; no modifiers required - Maximum 1 unit per delivery - Applies to vaginal and cesarean section deliveries 4. Verify doula provider enrollment status in Maryland Medicaid before processing claims—only certified doulas enrolled in ePREP as "Doula Provider" type are eligible for reimbursement 5. Do NOT require prior authorization for doula services—treat as self-referred benefit through December 31, 2025 6. Implement member eligibility tracking: services are covered from enrollment date until 180 days postpartum OR maximum service units exhausted, whichever occurs first 7. Train billing staff that this policy supersedes previous transmittals PT 24-23, PT 31-23, PT 37-22, and PT 66-23 CONSEQUENCES: Claims billed with incorrect codes, modifiers, place-of-service codes, or unit amounts will be denied. Failure to remove prior authorization requirements may cause claim delays and rejections from MCOs.