MedicaidCoverageMedium impact
Maximum Daily Quantity Limits for Non-Physician Prenatal Patient Education, Postpartum Parenting Education, Advocacy and Connection to Appropriate Resources, and Doula Support During or After Miscarriage or Abortion Units of Service
Illinois Medicaid - HFS·IL · OB-GYN·Provider Notice
Effective date
May 1, 2026
We identified it
Jun 16, 2026
Summary
Illinois Medicaid has established maximum daily quantity limits for doula services effective May 1, 2026. New limits include 2-hour daily caps for prenatal education and miscarriage/abortion support, and 4-hour caps for postpartum education services.
Action Required
Immediately: Billing team must update system to enforce daily quantity limits for doula service codes S9445 (8 units max), S9444 (16 units max), and T1032 (8 units max). All services must be billed in 15-minute increments. Providers must document exact start and end times in medical records for each encounter. Claims without proper time documentation will be subject to audit and recoupment.