Provider Alerts

In accordance with All Plan Letter (APL) 22-031, Doula Services are a covered benefit effective January 1, 2023. The following provider alert provides information regarding Doula Services, as well as provider enrollment requirements and billing, claims and payment information. For background information regarding Doula Services, please refer to this link provided by the Department of Health Care Services (DHCS), Link:
https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/ APL2022/APL22-031-Doula-Services.pdf

Covered Doula Services:

Doula services are provided for prenatal, perinatal, and postpartum Members. Doula services can be provided virtually or in person with locations in any setting.

An initial recommendation for doula services includes the following authorizations:

• One initial prenatal visit.
• Up to eight additional visits can be provided in any combination of prenatal and postpartum visits.
• Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion, or miscarriage.
• Up to two extended three-hour postpartum visits after the end of a pregnancy. Doula services can be recommended by utilizing the Medi-Cal Doula Services Recommendation form. Please utilize the following link to access the form: https://www.dhcs.ca.gov/provgovpart/Documents/DoulaREC.pdf

If a member requests or requires pregnancy-related services that are available through Medi-Cal, then the doula should work with the Member’s Primary Care Provider (if that information is available) or work with Health Plan of San Joaquin (HPSJ) to refer the Member to a Network Provider who is able to render the service. These Medi-Cal services include but are not limited to:

• Behavioral health services
• Belly binding after cesarean section by clinical personnel
• Clinical case coordination
• Health care services related to pregnancy, birth, and the postpartum period
• Childbirth education group classes
• Comprehensive health education, including orientation, assessment, and planning (Comprehensive Perinatal Services Program services)
• Hypnotherapy (non-specialty mental health service)
• Lactation consulting, group classes, and supplies
• Nutrition services (assessment, counseling, and development of care plan)
• Transportation
• Medically appropriate Community Supports services

Non-Covered Services:
• Belly binding (traditional/ceremonial)
• Birthing ceremonies (i.e., sealing, closing the bones, etc.)
• Group classes on babywearing
• Massage (maternal or infant)
• Photography
• Placenta encapsulation
• Shopping
• Vaginal steams
• Yoga

Provider Enrollment

Network Providers, including those who will operate as Providers of Doula Services, are required to enroll as Medi-Cal Providers, consistent with APL 22-013 or any superseding APL if there is a state-level enrollment pathway for them to do so.

Billing, Claims, and Payments

HPSJ will reimburse Doulas in accordance with their Network Provider contract. Claims for doula services must be submitted with allowable current procedural terminology codes as outlined in the Medi-Cal Provider Manual. Doulas cannot double bill, as applicable, for doula services that are duplicative to services that are reimbursed through other benefits.

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If you have questions or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.