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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyUniversity of Utah Doula Coverage | OpenPayer
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    CurrentUniversity of Utah Health PlansPolicy REIMB-042

    Doula Services Reimbursement Policy

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    This policy governs coverage, prior authorization, billing, and reimbursement requirements for doula prenatal, labor-support, and postpartum services for eligible University of Utah Health Plans members. It addresses Commercial and Medicaid plan handling, including applicable Utah Medicaid coverage rules.

    Policy Summary
    PayerUniversity of Utah Health Plans
    PolicyDoula Services Reimbursement Policy
    Policy CodePolicy REIMB-042
    Change TypeNo material changes
    Effective DateOctober 1, 2026
    Last ReviewSep 23, 2026
    Next Review DateSeptember 1, 2027
    Key ActionObtain prior authorization for doula services and comply with approved provider requirements.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    16 units / 240 minutesMaximum prenatal doula services per pregnancy
    12 units / 180 minutesMaximum postpartum doula services per pregnancy
    1 visitAllowed labor and delivery support per pregnancy
    12 monthsClaim submission period

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    Coverage Criteria

    Commercial Plan Doula Coverage Criteria

    Doula labor support services are covered for eligible pregnant members when all coverage and operational requirements below are met.

    ALL of the following

    • Member is eligible for doula services during pregnancy, including a pregnancy that ends in miscarriage, stillbirth, or termination of pregnancy.
    • Services are provided in an approved setting. Home settings are not covered unless the employer group specifically allows home-based services.

      Coverage eligibility and reimbursement are subject to the applicable setting requirements.

    • Services are furnished by an approved provider and satisfy prior authorization requirements.

      Prior authorization is required for coverage and reimbursement.

    • Covered service limits per pregnancy

      • Prenatal visits, including telehealth visits, are provided within the allowance of 16 units of T1032, totaling 240 minutes.<= 16 units / 240 minutes
      • Postpartum visits, including telehealth visits, are provided within the allowance of 12 units of T1032, totaling 180 minutes.<= 12 units / 180 minutes
      • Labor and delivery support consists of no more than 1 labor support visit (T1033), reimbursed at a flat rate regardless of length of time.1 visit
    • Claims are received within 12 months after the date of service.<= 12 months

    Medicaid Coverage Determination

    Medicaid coverage is determined through the following pathway, in order.

    Apply the first applicable pathway

    • Utah Medicaid has a published coverage position that applies to the service; determine coverage under the Utah Medicaid position.
    • Utah Medicaid has no published coverage position, but applicable InterQual criteria are available; determine medical necessity and coverage using the InterQual criteria.
    • Utah Medicaid has no published coverage position and applicable InterQual criteria are not available; apply the U of U Health Plans Commercial doula coverage criteria.

      Use the Commercial plan criteria in this section as the fallback coverage criteria.

    Operational Medicaid review

    • Check the Utah Medicaid official publications for current policies and coverage: https://medicaid.utah.gov/utah-medicaidofficial-publications/

    Coding and Reimbursement

    Doula birth worker timed servicesHCPCSCovered
    T1032Services performed by a doula birth worker, per 15 minutes
    Doula labor and delivery supportHCPCSCovered
    T1033Services performed by a doula birth worker, per diem
    Required diagnosis codingICD-10
    Z33.1Pregnant state, incidental
    Z39.2Encounter for routine postpartum follow-up
    CPT codesCPT
    No codes listed
    Prenatal T1032 allowance
    ServicePrenatal doula visits (T1032)
    Allowance16 units totaling 240 minutes per pregnancy
    TelehealthTelehealth visits are included
    Postpartum T1032 allowance
    ServicePostpartum doula visits (T1032)
    Allowance12 units totaling 180 minutes per pregnancy
    Telehealth

    Provider and Billing Actions

    Prior Authorization

    Obtain prior authorization before providing services

    Obtain prior authorization for doula services and comply with approved provider requirements. Coverage and reimbursement are subject to prior authorization.

    Prior Authorization

    Authorize services beyond standard allowances

    Request authorization for additional postpartum services beyond 12 units or 180 minutes per pregnancy, and for additional prenatal services beyond 16 units or 240 minutes per pregnancy.

    • Postpartum: 12 T1032 units or 180 minutes per pregnancy
    • Prenatal: 16 T1032 units or 240 minutes per pregnancy

    Definitions

    Doula
    DefinitionA trained professional
    Physical supportProvides continuous physical support during the perinatal period
    Emotional supportProvides continuous emotional support during the perinatal period
    Informational supportProvides continuous informational support during the perinatal period
    Doula services
    Before birthServices provided before birth, including prenatal visits
    During labor and deliveryOne labor and delivery support visit
    Policy Summary
    PayerUniversity of Utah Health Plans
    PolicyDoula Services Reimbursement Policy
    Policy CodePolicy REIMB-042
    Change TypeNo material changes
    Effective DateOctober 1, 2026
    Last ReviewSep 23, 2026
    Next Review DateSeptember 1, 2027
    Key ActionObtain prior authorization for doula services and comply with approved provider requirements.
    SourceLink
    On This Page
    Coverage CriteriaCoding and ReimbursementProvider and Billing ActionsDefinitions
  1. Use the Utah Medicaid code Look-Up tool when evaluating applicable Medicaid coverage.
  2. A CPT or HCPCS code covered by Utah State Medicaid may still require further evaluation to determine medical necessity for coverage.
    3. Telehealth visits are included
    Labor and delivery T1033 allowance
    ServiceLabor and delivery doula support (T1033)
    Allowance1 visit during labor and delivery per pregnancy
    PaymentPaid at a flat rate regardless of duration
    Claim filing limit
    RequirementClaims must be received within 12 months after the date of service
    Applies toDoula services claims
    Timing basisThe filing period begins on the date of service
    Denial Risk

    Do not bill unauthorized home-setting support

    Do not bill doula labor support provided in a home setting unless the employer group specifically allows a home setting.

    Billing Rule

    Submit claims within the filing limit

    Submit claims within 12 months after the date of service.

    After birthServices provided after birth, including postpartum visits