Insurance codes for doulas can vary depending on the country and the insurance provider. In the United States, for example, there are specific billing codes used for reimbursement through Medicaid and private insurance companies. Here are some common codes and information that might be relevant:
- CPT (Current Procedural Terminology) Codes:
- There is no specific CPT code solely for doula services, but doulas might use other related codes for services provided. For instance, some doulas might use codes related to education, counseling, or labor support.
- S9442: Birthing classes, non-physician provider, per session.
- 99499: Unlisted evaluation and management service (this is a more general code that might be used if a specific code for doula services is not available).
- HCPCS (Healthcare Common Procedure Coding System) Codes:
- S9443: Lactation classes, non-physician provider, per session.
- T1015: Clinic visit/encounter, all-inclusive (this can sometimes be used for community-based doula programs).
- Modifiers:
- Some services might require modifiers to specify the type of service provided.
- Medicaid Codes:
- Medicaid programs in some states have specific codes for doula services. For instance, in Minnesota, the code T1001 is used for a home visit by a registered nurse, which might be used for doula visits in some contexts.
- State-Specific Programs:
- Some states have implemented their own coding systems for doula services. For example, Oregon and Minnesota have Medicaid programs that cover doula services with specific billing codes.
- Some states have implemented their own coding systems for doula services. For example, Oregon and Minnesota have Medicaid programs that cover doula services with specific billing codes.
Doula on BornBir:
I recently submitted a claim which was rejected because of an incorrect modifier code. For the initial prenatal visit, I used the code 99600 with modifier HD-U7. I am not sure if I should have not included the U7. The other codes I used were 59409 -HD for labor support/vaginal birth, and 99100-HD for postpartum visit. The feedback I got from my client who spoke with the insurance company was it was denied because of an incorrect modifier code on 99960.
Suggestions:
Typically, the HD modifier is used to indicate Medicaid, but the U7 modifier may not be necessary or valid in this context. For the initial prenatal visit, you might want to try submitting the code 99600 with just the HD modifier, omitting the U7.It's important for doulas to verify with insurance providers and state Medicaid programs for the exact codes and billing procedures as these can vary.
