CurrentCignaPolicy A002

Midwife, home birth, and non-clinical maternal services administration

Governs coverage and administrative rules for professional fees related to midwife services, planned home births, and non-clinical maternal support under standard Cigna benefit plans; applies to members and providers where state law and plan terms permit.

Policy Summary

PayerCigna

PolicyMidwife, home birth, and non-clinical maternal services administration

Policy CodePolicy A002

Change TypeNo material change

Effective Date8/8/2025

Next Review Date8/8/2026

Key ActionVerify provider licensure/certification and network status to determine applicable in‑network or out‑of‑network benefit level for midwife and home birth professional fees.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

A002Coverage Policy Number

8/8/2025Effective

8/8/2026Next review

2-3x neonatal riskSafety note

2Min attendants

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Coverage Criteria for Midwife, Home Birth, and Related Services

Coverage criteria for midwife and home birth services

Covered when ALL of the following conditions are met:

Provider is acting within the scope of his/her license or certification under applicable state law (required for coverage).

Provider type

Licensed/Certified Nurse Midwife (CNM) providing services within scope of license/certification.
Non-nurse midwife (e.g., Certified Midwife, Certified Professional Midwife, Direct-Entry Midwife, Lay Midwife) when acting within scope of license/certification under applicable state law.

Professional fees for home birth (delivery and immediate medically necessary postpartum care) are covered only when provided by a health care provider acting within scope of license/certification under applicable state law.

Benefit level

In-network benefit level when services are provided by an in-network midwife or other in-network health care provider.
Out-of-network benefit level when services are provided by an out-of-network midwife or health care provider and the customer's plan allows out-of-network benefits.

Services provided outside the scope of license or certification under applicable state law are not covered.

Doula services (non-clinician maternal support) are not covered unless required by state regulation or the customer's benefit plan.

Network Adequacy Provision does not apply to midwife services if a licensed in-network provider capable of rendering services is available; continuity/transition of care provisions may apply.

Planned Home Birth operational criteria

Planned home births are subject to the following operational requirements and definitions:

Planned home births must be attended by a physician or a midwife certified by the American Midwifery Certification Board (or predecessor) or whose education and licensure meet the International Confederation of Midwives Global Standards for Midwifery Education, practicing within an integrated and regulated health system.

At least two care providers must attend the planned home birth, with at least one appropriately trained individual whose primary responsibility is care of the newborn infant.

Appropriate equipment for neonatal resuscitation must be available at the home birth setting.

There must be ready access to medical consultation and assurance of safe, timely transport to a nearby hospital with a pre-existing arrangement for transfers.

Low risk: defined as women whose history and condition suggests little likelihood of complications during pregnancy, labor and/or birth; home birth criteria align with this low-risk designation.

Coding and Benefit Level Guidance

Benefit level coding guidancemixed

	in-network benefit level when services are provided by an in-network nurse midwife
	out-of-network benefit level when services are provided by an out-of-network nurse midwife and when out-of-network benefits exist
	in-network benefit level when services are provided by an in-network health care provider (home birth)
	out-of-network benefit level when services are provided by an out-of-network health care provider and when out-of-network benefits exist (home birth)

Not specified in this sectionmixed

No codes listed

inv-05: Home birth coverage condition

Coverage conditionProvider must act within the scope of his/her license or certification under applicable state law to be eligible for coverage of home birth professional fees.

Included servicesProfessional fee coverage includes delivery and immediate medically necessary postpartum care for the mother when provided within scope of license/certification.

Plan limitationsCoverage is subject to the terms and limitations of the applicable Cigna benefit plan and may be limited by certification/licensure requirements.

inv-06: Minimum attendant count

Minimum attendantsAt least two care providers must attend the planned home birth.

Provider Actions, Prior Auth, and Operational Requirements

Prior Authorization

Prior authorization, licensure, and network-level rules

Coverage of midwife and home birth professional fees is subject to the terms, conditions and limitations of the member’s applicable benefit plan, and may be limited by health care professional certification or licensure requirements and state mandates. In-network vs out-of-network benefit levels apply as stated in the plan; Network Adequacy Provision (NAP) does not apply to midwife services if a licensed in‑network provider capable of rendering services is available.

Services must be provided by a provider acting within the scope of license or certification under applicable state law.
Professional fees are paid at in-network benefit level when provided by an in-network midwife; out-of-network benefit level applies when out-of-network benefits exist.

Documentation Required

Systems and supports required for planned home birth

Planned home births must be supported by an integrated system of care: a physician or AMCB‑certified (or equivalent educated/licensed) midwife practicing within an integrated and regulated health system, attendance by at least two care providers with one primarily responsible for the newborn, availability of neonatal resuscitation equipment, ready access to medical consultation, and pre‑existing arrangements assuring safe, timely transport to a nearby hospital.

Definitions and Term Clarifications

inv-09: Certified Nurse Midwife (CNM) — definition entry

DefinitionCertified Nurse Midwife (CNM): a registered nurse who completed a graduate-level nurse‑midwifery program and passed the American Midwifery Certification Board exam.

Scope of careCNMs provide primary health care for women including pregnancy, labor, birth, early postpartum care, and newborn care (first 28 days), in various settings.

Practice authorityCNMs practice under direct supervision of a licensed physician or independently when authorized by state law.

inv-10: Non-nurse midwife types — CM, CPM, DEM, LM descriptions

Certified Midwife (CM)Completed a graduate-level midwifery degree and passed AMCB certification; qualified to provide the same level of care as a CNM.

Certified Professional Midwife (CPM)

Policy Summary

PayerCigna

PolicyMidwife, home birth, and non-clinical maternal services administration

Policy CodePolicy A002

Change TypeNo material change

Effective Date8/8/2025

Next Review Date8/8/2026

Key ActionVerify provider licensure/certification and network status to determine applicable in‑network or out‑of‑network benefit level for midwife and home birth professional fees.

SourceLink

On This Page

Licensed certified nurse-midwife: a registered nurse with advanced training who is registered and licensed to practice midwifery; provides care during pregnancy, labor, birth, early postpartum period, and newborn care under physician supervision or independently if authorized by state law.

Newborn responsibility

At least one attendant must have primary responsibility for the care of the newborn infant.

Operational requirementAttendance requirement is part of the systems needed to support planned home birth and must be met for coverage considerations.

At least two care providers must attend the birth; at least one must be primarily responsible for newborn care.
Appropriate neonatal resuscitation equipment must be available on-site.
There must be ready access to medical consultation and a pre-existing transfer arrangement for timely hospital transport.

Meets North American Registry of Midwives (NARM) certification requirements; eligibility via apprenticeship, portfolio evaluation, or graduation from a midwifery program; state practice privileges vary.

Direct-Entry Midwife (DEM)May have no national certification or licensing; legal rights and licensing vary by state; some DEMs may also be CPM, CM, or CNM.

Lay Midwife (LM)Uncertified or unlicensed midwife with no formal education; licensing and legal status vary by state.

inv-11: Doula — non-clinician support definition and coverage note

DefinitionDoula: a non‑clinician trained to provide emotional, informational, and psycho‑social support during pregnancy, childbirth, and the postpartum period.

CertificationAfter training, a doula may obtain certification from organizations such as DONA or the International Childbirth Education Association.

Coverage noteDoulas are generally non‑clinical and their services are not covered unless required by state regulation or the customer's benefit plan.

inv-12: Low risk — definition (women with low likelihood of complications)

DefinitionLow risk: women whose history and condition suggest there is little likelihood of complications during pregnancy, labor, and/or birth.

Context for home birthHome birth is generally appropriate only for low‑risk women and when qualified health care professionals and required systems are in place.

Clinical implicationLow‑risk designation aligns with criteria such as singleton, cephalic presentation, appropriate gestational age, and spontaneous labor.

inv-13: Low risk — alternate/duplicate low-risk definition entry

Alternate phrasingLow risk: a term used by clinicians to describe women whose history and condition suggests that there is little likelihood of complications during pregnancy, labor, and/or birth.

Use in policyThis definition is used to determine appropriateness of planned home birth and applicability of coverage criteria.

Decision impactDesignation as low risk is a prerequisite for home birth considerations in this policy.

inv-14: Licensed certified nurse-midwife — definition and scope

DefinitionLicensed certified nurse‑midwife: a registered nurse with advanced training who is registered and licensed to practice midwifery.

ScopeProvides care and advice during pregnancy, labor, birth, early postpartum period, and newborn care across multiple settings.

SupervisionMay practice under direct supervision of a licensed physician or independently where state law authorizes independent practice.

inv-15: In-network benefit level — definition

DefinitionIn‑network benefit level: the coverage level applied when care is provided by a provider contracted with Cigna.

ApplicationProfessional fees for services provided by an in‑network midwife or home birth provider are covered at the in‑network benefit level, per the applicable benefit plan.

Plan dependencySpecific member cost‑sharing and limits depend on the customer's Cigna benefit plan terms.

inv-16: Out-of-network benefit level — definition and conditional coverage

DefinitionOut‑of‑network benefit level: the coverage level applied when care is provided by a provider not contracted with Cigna and who does not participate in the customer's network.

Conditional coverageOut‑of‑network coverage applies only when the customer's health benefit plan allows out‑of‑network services; otherwise services are not covered.

Effect on home birthProfessional fees for home birth provided by out‑of‑network providers are reimbursed at the out‑of‑network benefit level only if the member's plan permits such benefits.