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Doula Services

Revised: 02-29-2016

Overview

Effective with services provided on or after July 1, 2014, Minnesota Health Care Programs (MHCP) covers doula services provided by certified doulas for fee-for-service (FFS) recipients. These services include emotional and physical support for pregnant women. For recipients enrolled in managed care, verify eligibility and confirm coverage of doula services with the recipient’s managed care organization (MCO).

Eligible Providers

Doulas who are registered with the Minnesota Department of Health (MDH) and are certified by one of the following organizations are eligible to provide and bill for services under a supervising professional’s NPI:

  • Association of Labor Assistants and Childbirth Educators (ALACE)
  • Birthworks
  • Childbirth International
  • Childbirth and Postpartum Professional Association (CAPPA)
  • Commonsense Childbirth Inc.
  • Doulas of North America (DONA)
  • International Center for Traditional Childbearing (ICTC)
  • International childbirth Education Association (ICEA)
  • Supervision

    You must provide all doula services under the supervision of one of the following MHCP-enrolled providers:

  • • Physician
  • • Nurse practitioner
  • • Certified nurse midwife
  • Eligible Recipients

    All pregnant MA and MinnesotaCare recipients are eligible to receive doula services from certified providers.

    Covered Services

    Covered services are limited to childbirth education and support services, which include emotional and physical support provided at the following times:

  • • Before childbirth (antepartum)
  • • Labor and delivery
  • • Postpartum
  • MHCP covers up to seven sessions, one of which must be for labor and delivery. The remaining six sessions may be used in the antepartum and postpartum periods as needed. Refer to the Authorization Requirements section of this page for information on adding additional sessions.

    Noncovered Services

    Travel time and mileage are not covered services.

    Documentation Requirements

    The documentation requirements for doulas are the same as those for all MHCP providers. Refer to the Provider Requirements section of this manual for documentation requirements.

    Birth Weight Requirement

    Refer to the Inpatient Hospital Services section for birth weight requirements.

    Authorization Requirements

    To provide additional sessions, the doula must request prior authorization following the guidelines in the Authorization section of this manual. Include documentation supporting the medical necessity of the additional sessions with the request.

    Billing

    Refer to the Billing Policy and Provider Requirements sections of this manual for an overview of MHCP billing policies and procedures.

  • • Bill using the 837P
  • • Enter the NPI for the supervising physician, nurse practitioner or certified nurse midwife in the rendering box in MN–ITS
  • • If the billing entity has an additional NPI, enter that NPI in the Pay To box in MN–ITS
  • • Bill all non-labor and non-delivery sessions with S9445 and the U4 modifier
  • • Bill the labor and delivery session with 99199 and the U4 modifier
  • Legal References

    Minnesota Statutes, section 144.651, subd. 10 (Health Care Bill of Rights: Participation in Planning Treatment; Notification of Family Members)
    Minnesota Statutes, section 148.995, subd. 2
    (Definitions: Certified Doula)
    Laws of Minnesota 2014, chapter 291, article 4, section 23
    (amended section 148.995, subd. 2)
    Minnesota Statutes, section 148.996
    (Registry)
    Laws of Minnesota 2014, chapter 291, article 4, section 24
    (amended section 148.996, subd. 2)
    Minnesota Statutes, section 256B.0625, subd. 28b
    (Covered Services: Doula Services)

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    Updated: 2/29/16 10:21 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 2/29/16 10:21 AM