KMAP BULLETIN: Doulas Enrollment and Coverage
Date: 05/28/24
Effective with enrollment dates on and after June 1, 2024,
Kansas Medicaid will recognize Doulas as non-physician
providers and cover doula services from the date of confirmed
conception through the postpartum period (1 year after delivery).
The coverage will be effective with dates of service on and after
July 1, 2024. Coverage will include different types of doula
services:
• Community-based doulas
• Prenatal doulas
• Labor and birth doulas
• Postpartum doulas
Doula services may only be provided during pregnancy, labor
and delivery, miscarriage, and within one year of the end of a
member’s pregnancy.
Documentation and Service Recommendation Requirements:
A physician or other licensed healthcare provider must recommend
doula services. The licensed healthcare providers qualified to
recommend doula services are those licensed in the state of Kansas
as registered nurses, clinical social workers, nurse practitioners,
physician assistants, certified nurse midwives, or physicians.
The initial recommendation can be provided through the following
methods:
• Written recommendation in member’s record,
• Standing order for doula services by plan, physician group,
or another group by a licensed provider, or
• Use a standard Doula Services Referral Form from the
Kansas Medical Assistance Program (KMAP) website that a
member can provide to the licensed provider, or a doula can
provide to a member to obtain the licensed provider's
signature.
Doula must obtain the signed form before the service and maintain
documentation of the recommendation.
Enrollment Requirements for Doulas:
• Online enrollment application in one of the ways listed
below:
1. Practice and bill independently, OR
2. Practice and bill as part of a doula group.
• Each Doula must enroll with their own National Provider
Identifier (NPI) (type 1) to provide the covered services
with taxonomy code 374J00000X.
• Doula will be enrolled with a new provider type/provider
specialty (PT/PS) 32/212 (Non-physician/Doula).
• Doula must be certified with a doula training organization
(training pathway 1) OR complete a minimum of 30 hours
of training (training pathway 2).
• The required documents should be attached to the
application. The enrolling Doula will complete the Primary
Doula Attestation Form to attest that they have provided
support at a minimum of three births.
Download the Doula Attestation Form packet here for full
instructions.
Covered Doula Services:
The following services are covered for Doulas:
| Visit Type | Code | Primary Diagnosis Code | Limit per Pregnancy | Rate |
|---|---|---|---|---|
| Prenatal Visits | T1032 | Z33.1 | 28 (15-minute units) | $15.00 per unit |
| Attendance at Labor and Delivery | T1033 | Z33.1 | 1 Visit | $500 |
| Postpartum Visits | T1032 TS | Z39.2 | 25 (15-minute units) | $15.00 per unit |
Doulas are allowed to bill T1033 once per 280 days. If billed more
frequently, documentation must accompany the claim to indicate that
these charges represent another pregnancy. If no documentation is
attached, the claim will be denied, and any prenatal or postpartum
visits related to that time frame will be recouped.
* The rates noted in this bulletin are subject to future changes.
Providers should check the KMAP website for the most up-to-date
rates.
Note: The effective date of the policy is June 1, 2024. The
implementation of State policy by the KanCare Managed Care
Organizations (MCOs) may vary from the date noted in the KMAP
bulletins. The KanCare Open Claims Resolution Log on the
KMAP Bulletins page documents the MCO system status for policy
implementation and any associated reprocessing completion dates
once the policy is implemented.
For the changes resulting from this provider bulletin, view the updated Professional
Fee-for-Service Provider Manual, Section 8400, pages 8-19 through 8-22.