CommercialCoverageMedium impact
Delaware Doula Services Mandate
Highmark·DE · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jul 4, 2026
Summary
Effective January 1, 2026, Delaware insurers must cover doula services for pregnant and birthing individuals under individual, small group, and large group fully insured policies. Coverage includes prenatal visits, postpartum visits, labor/birth attendance, and additional visits as clinically recommended. Doulas must be certified per Delaware DMMA requirements, and billing uses HCPCS codes T1032 and T1033, or preventive counseling codes 99401-99403 with diagnosis code Z391.
Action Required
By December 31, 2025: Billing team must (1) update billing software to recognize and process HCPCS codes T1032 and T1033 for doula services, and CPT codes 99401, 99402, 99403 when paired with diagnosis code Z391; (2) establish verification process to confirm doula certification per Delaware DMMA § 530 requirements before processing claims; (3) create encounter documentation templates requiring providers/clinicians to recommend doula service duration and visit frequency; (4) update payer files in billing system to activate doula service coverage for Delaware Highmark plans (CPA/SEPA, DE, NENY, WNY, WPA/NEPA, WV) effective January 1, 2026; (5) train billing and credentialing staff on new doula certification and enumeration requirements per Reimbursement Policy (RP)-068. Failure to implement will result in claim denials for non-compliant doula service submissions starting January 1, 2026.