Doulas — Payment and Billing Policy
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This policy governs reimbursement and billing rules for doula services provided to pregnant members enrolled in UCare MHCP products (PMAP, Connect, MinnesotaCare). It specifies provider eligibility, covered services, modifiers, and applicable codes.
No material clinical or coverage changes in this revision.
Coverage and Billing Criteria for Doula Services
Coverage criteria for doula services
Coverage and billing rules for doula services provided to eligible pregnant UCare members by enrolled doula providers.
Doula coverage criteria
UCare covers doula services under MHCP with session limits and billing rules; travel expenses excluded.
Codes, Modifiers, and Visit Limits
Provider Eligibility, Enrollment, and Authorization
Enroll with MDH and UCare to bill for doula services
Doulas who are registered with the Minnesota Department of Health (MDH) may enroll as doula providers for UCare and, once enrolled, are permitted to provide and bill for doula services for eligible members.
- Enrollment requirement: Registration with MDH is required to enroll as a doula provider with UCare.
- Billing eligibility: Only UCare-enrolled doula providers may bill UCare for doula services for eligible members.
Confirm prior authorization rules and 18‑session threshold
Follow UCare’s current prior authorization, notification, and threshold rules; note that under MHCP products UCare covers up to 18 doula sessions without prior authorization effective May 1, 2024.
- Check UCare’s prior authorization page for the most current authorization and notification requirements.
- Session threshold: Up to 18 sessions are covered without prior authorization under MHCP (effective 5/1/2024).
Definitions
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