MedicaidCoverageMedium impact
Coverage of Doula Services for HealthChoice and Fee-for-Service Enrollees, Effective February 21, 2022
Maryland Medicaid·MD · OB-GYN, Family Medicine·Doulas
Effective date
Feb 21, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid (HealthChoice MCOs and Fee-for-Service) now covers doula/birth worker services effective February 21, 2022, for pregnant individuals and those within 180 days postpartum. Billing teams must implement three new service codes (W3701, W3700, W3702) with specific place-of-service and modifier requirements, and ensure doulas are properly enrolled as Medicaid providers before claims can be processed.
Action Required
By February 21, 2022: (1) Billing team must update billing system to recognize and process three new doula service codes: W3701 (prenatal visits at $16.62/15-min unit, max 4 units), W3700 (labor & delivery flat rate $350, in-person only at hospital/birthing center), and W3702 (postpartum visits at $19.62/15-min unit, max 4 units). (2) Configure system to enforce 8-visit maximum per birthing parent (any combination of W3701 and W3702). (3) Ensure modifiers are correctly applied: use modifier GT for telehealth services (W3701 and W3702 only; W3700 cannot be telehealth). (4) Update place-of-service code requirements in billing software per policy table (home=04/12, doctor's office=11/50/22, community=11/99, telehealth=02/12, hospital L&D=21/25). (5) Verify doula providers are enrolled in Maryland Medicaid ePREP as Type 1 (individual) or Type 2 (group) before submitting claims; unenrolled doulas will be denied. (6) For MCO enrollees, confirm contracted doulas meet MDH-approved certification requirements from one of eight listed organizations. (7) Front-line staff should note that prior authorization is NOT required for doula services, but eligibility must be verified (pregnant or within 180 days postpartum). Claims submitted before provider enrollment or with incorrect modifiers/place-of-service codes will be denied.