Category: #unitedhealthcare

The new coverage policy applies to Medicaid, Healthy Michigan Plan, MI Health Link, MIChild, Maternity
Outpatient Medical Services Programs.

Effective 01/01/23 – Michigan Medicaid members that belong to the above mentioned programs will be able to receive services from a certified doula during the the prenatal, labor and delivery, and postpartum
periods.

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Doula- non clinical professional that provides physical, emotional, and educational support services to pregnant individuals.

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In order for the Doula Services to be covered they need to be recommended by a licensed healthcare
provider.

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Some of the Doula Services may include: (partial list) complete list is available click here.

Prenatal services, which include:
o Promoting health literacy and knowledge;
o Assisting with the development of a birth plan;
o Supporting personal and cultural preferences around childbirth;

Labor and delivery services, which include:
o Providing continual physical comfort measures, information, and emotional support;
o Advocating for beneficiary needs; and

Postpartum services, which include:
o Educating regarding newborn care, nutrition, and safety;
o Supporting breastfeeding;
o Providing emotional support and encouraging self-care measures;

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Doula services are expected to be covered for face-to-face visits with the patient. Although the prenatal and Postpartum services may be done vial telemedicine, please MDHHS telemedicine policy.

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Frequency: up to 6 visits are allowed plus 1 extra visit during the delivery. The duration of each visit needs to be at least 20 minutes. If the patient requires over the max allowed number of visits, then the provider may request more via PA process.

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Documentation requirements: doulas need to document the start and end time of the visit for each patient. The documentation should include a description of the professional services rendered and information regarding the source of the licensed healthcare provider recommendation for services.

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Reimbursement: in order to receive reimbursement doulas need to be a registered Michigan Medicaid Provider. Reimbursement amounts as follows:

Prenatal visit: S9445 Modifier- HD ICD-10 codes- Prenatal: Z33.1Postpartum: Z39.2 6 total visits Fee-$75 per visit

Attendance at Labor and Delivery: CPT code- T1033 Modifier- HD ICD-10 Code- Z33.1 Max 1 visit Fee- $700

For complete information regarding coverage/reimbursement/provider enrollment, please visit Michigan Medicaid Site click here.

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Find this type of blog post interesting? Follow my blog for more healthcare related topic news: reimbursement, prior authorization, coverage, reimbursement, medical coding and billing.

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