1

Doula Billing Manual

The doula benefit program is administered by the Colorado Department of Health Care Policy & Financing (the Department). This billing manual describes information regarding the benefit's programmatic components and billing requirements. The information in this manual is subject to change as the Department periodically modifies the doula benefit program’s benefits and services. The manual will be updated as new policies are implemented.

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for general information about Health First Colorado (Colorado's Medicaid program). The manual provides information about billing Health First Colorado, reimbursement policies, provider participation, eligibility requirements, and other useful information.

Table of Contents

Program Overview

On July 1, 2024, the Colorado Department of Health Care Policy and Financing (the Department) implemented a doula benefit for Health First Colorado members. This program is based on legislation SB23-288.

Rules and Regulations

The doula benefit program is administered by the Department. Rules governing the program are outlined in the Code of Colorado Regulations 10 C.C.R. 2505-10 8.734. Providers are required to comply with all the rules and guidance provided by the Department and are encouraged to contact the Department's policy specialist with any questions. Contact HCPF_MaternalChildHealth@state.co.us. Updates to policy and guidance will be published in this manual. Providers will be given notice of updates through the Department’s monthly Provider Bulletin

The doula benefit is a program for pregnant people and people who have given birth who receive Health First Colorado benefits. The program gives people access to doula care, including prenatal, labor and delivery, and postpartum support. 

To be eligible for the program, a person must meet the following criteria:

  • Be eligible for Health First Colorado
  • Be pregnant or have given birth within the last 365 days

This benefit includes three categories of services and is available to all eligible Health First Colorado members.

  • Prenatal support
  • Continuous labor and delivery support
  • Postpartum support

The intent of this benefit is to leverage the community-based doula model that improves outcomes for pregnant people through continuous labor support with wraparound pre and postnatal care. This benefit is not a substitute for clinical obstetric care or behavioral health care with licensed providers. Additionally, while many doulas have other qualifications that may support pregnant and postpartum people, this does not include other support services for pregnant, laboring and postpartum people that would fall outside a doula’s scope—including but not limited to childbirth education, clinical or medical tasks, lactation services, massage therapy or infant sleep support.

Visit the Reproductive and Maternal Health Programs and Resources web page for more information on the doula benefit.

Contact HCPF_MaternalChildHealth@state.co.us with questions.

Back to Top

Provider Enrollment and Participation 

Providers must be enrolled as a Health First Colorado provider to treat a Health First Colorado member and to submit claims for payment to Health First Colorado.

Visit the Provider Enrollment web page if interested in becoming a Health First Colorado provider. Training on doula program enrollment can be found at the Department’s Doula web page under doula enrollment training.

Doula benefit program providers must be enrolled in Health First Colorado under the doula specialty. 

Back to Top

Billing Information

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for general billing information.

Covered Doula Services

Doula services are billed using two Healthcare Common Procedure Coding System (HCPCS) procedure codes, two International Classification of Diseases (ICD)-10 diagnosis codes, and a combination of modifier codes if services are delivered via telemedicine. The modifier codes shown below should only be used in circumstances involving telemedicine.

Covered services are limited to 180 minutes of prenatal care and 180 minutes of postpartum care per member, and one instance of labor and delivery per member pregnancy during a 12-month period regardless of the number of doula providers who treat that member. 

A member or doula cannot distribute that amount differently, and those services are maxed out to the member. For example, if one doula is reimbursed for one 60-minute visit and one 90-minute visit during the prenatal period, a second doula can only be reimbursed for the remaining 30 minutes (two units of service) for that same member. 

Should a doula identify a need beyond these additional approved services they may reach out to the member’s Regional Accountable Entity for care coordination.

Prenatal Doula Services: A doula can be reimbursed for up to 180 minutes of prenatal care per member at $25 per unit of service for HCPCS Procedure Code T1032. There is a limit of 12 units of service per member during a 12-month period (period starts at the time of the first doula claim).

Postpartum Doula Services: A doula can be reimbursed for up to 180 minutes of postpartum care at $25 per unit of service for HCPCS Procedure Code T1032. There is a limit of 12 units of service per member during a 12-month period (period starts at the time of the first doula claim).

Labor and Delivery: A doula can be reimbursed for labor and delivery services once during a 12-month period per member for HCPCS Procedure Code T1033. This code is reimbursed at $900 per service. The reimbursement per delivery is $900 regardless of how long labor and delivery lasts. The doula and member should discuss expectations and processes should the labor and delivery exceed the time that the doula is able to assist. 

Back to Top

Coding Table for Doula Services

Procedure CodeDescription (short)Required ICD-10 Diagnosis CodesLimitations per 12-month period
T1032

Doula birth worker services, billed per 15 minutes. Used for prenatal and postpartum services. 

 

This is a ‘timed’ code. 1 unit of service = 15 minutes of direct member contact services provided. Instructions for rounding increments are found below. 

 

Telemedicine service delivery is allowed. 

Prenatal 

Services: 

Z33.1

 

 

Postpartum Services: 

Z39.2

12 units of service (180 minutes) covered per member pregnancy for Prenatal services, 

 

and

 

12 units of service (180 minutes) covered per member pregnancy for Postpartum services

T1033

Doula birth worker services, per delivery. Used for labor and delivery services. 

 

This is an ‘untimed’ code. 1 unit of service = all doula services provided during a member’s labor & delivery. This code is only to be reported once per member, per delivery.

 

Telemedicine service delivery is not allowed. 

Z33.11 unit of service covered per member pregnancy

 

Modifier Codes for Telemedicine Service Delivery for T1032 OnlyDescription
FQThe service was furnished using audio-only communication technology.
FR

The supervising practitioner was present through two-way, audio/video communication technology. 

 

93

Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive -Audio-Only Telecommunications System 

 

95

Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

 

Back to Top

Reporting Units of Service

A. Timed and Untimed Codes

When reporting service units for CPT/HCPCS codes where the procedure is not defined by a specific timeframe ("untimed" CPT/HCPCS), the provider enters "1" in the field labeled "units." For untimed codes, units are reported based on the number of times the procedure is performed, as described in the CPT/HCPCS code definition.

Example 1: A member received doula birth worker services related to a delivery, represented by HCPCS "untimed" code T1033. Regardless of the number of minutes spent providing this service, only one unit of service is appropriately billed.

HCPCS code T1032 specifies that the direct (one-on-one) time spent in patient contact is 15 minutes. Providers report these "timed" procedure codes for services delivered on any single calendar day using HCPCS codes and the appropriate number of 15-minute units of service.

Example 2: A member received a total of 60 minutes of prenatal doula birth worker services codes using HCPCS "timed" code T1032 which is defined in 15-minute units, on a given date of service. The provider would then report 4 units of code T1032.

Back to Top

B. Counting Minutes for Times Codes in 15-Minute Units

When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed HCPCS code in the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 minutes, through and including 37 minutes, then 2 units should be billed. Time intervals for 1 through 8 units are as follows:

Billed Units IncrementTime Spent in Direct Patient Contact
1 unit of service8 minutes through 22 minutes
2 units of service23 minutes through 37 minutes
3 units of service38 minutes through 52 minutes
4 units of service53 minutes through 67 minutes
5 units of service68 minutes through 82 minutes
6 units of service83 minutes through 97 minutes
7 units of service98 minutes through 112 minutes
8 units of service113 minutes through 127 minutes

The pattern remains the same for treatment times in excess of 2 hours.

Example 3: A member received a total of 105 minutes of prenatal doula birth worker services codes using HCPCS "timed" code T1032 which is defined in 15-minute units, on a given date of service. The provider would then report 7 units of code T1032.

The provider must maintain documentation in accordance with 10 CCR 2505-10 8.130.2. that complies with state and federal regulations. The doula should be able to quickly identify and share information about each visit, including timestamps for the duration of each visit providing direct service to an eligible member. This is used to validate the number of units of service billed for reimbursement. 

Back to Top

Physical Health Managed Care 

Doula services are not included in Health First Colorado physical health managed care plans, however doula services are still covered benefits for members enrolled in those plans. All claims for Doula services should be billed to the Department’s Fiscal Agent, Gainwell Technologies, even if the member is attributed to a Health First Colorado physical health managed care plan. 

Back to Top

Place of Service

Doulas can provide prenatal and postpartum care in variety of settings, including the member’s home, clinics and provider offices, community-based settings or via telehealth. A full list of allowable places of service for doula services are indicated below. 

Labor and delivery services (T1033) cannot be provided via telemedicine with Place of Service codes 02 or 10. While doulas must provide in-person labor and delivery support, location can vary.

Official descriptors of the Place of Service can be found on the CMS website. 

 

Allowed Place of Service CodeDescription (short)
02Telehealth Provided Other than in Patient’s Home
03School
04Homeless Shelter 
05Indian Health Service Free-standing facility
06Indian Health Service Provider based facility
08Tribal 638 Provider-based Facility 
09Prison/ Correctional Facility 
10Telehealth Provided in Patient’s Home
11Office
12Home 
19Off Campus-Outpatient Hospital 
20Urgent Care Facility
21Inpatient Hospital 
22On Campus-Outpatient Hospital
23Emergency Room
25Birthing Center
50Federally Qualified Health Center
53Community Mental Health Center 
55Residential Substance Abuse Treatment Facility
57Non-residential Substance Abuse Treatment Facility 
71Public Health Clinic 
72Rural Health Clinic

Back to Top 

Contact Information

Contact the Provider Services Call Center with billing inquiries.

Contact the Department's Doula Benefit policy specialist at hcpf_maternalchildhealth@state.co.us for all other inquiries.

Back to Top

CMS 1500 Paper Claim Reference Table

The following paper form reference table shows required, optional, and conditional fields and detailed field completion instructions for the CMS 1500 claim form.

 

CMS Field Number & LabelField is?Instructions
1. Insurance TypeRequiredPlace an "X" in the box marked as Medicaid.
1a. Insured's ID NumberRequiredEnter the member's Health First Colorado seven-digit Health First Colorado ID number as it appears on the Medicaid Identification card. Example: A123456.
2. Patient's NameRequiredEnter the member's last name, first name, and middle initial.
3. Patient's Date of Birth/SexRequiredEnter the member's birth date using two digits for the month, two digits for the date, and two digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the member.
4. Insured's NameConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured's full last name, first name, and middle initial. If the insured used a last name suffix (e.g., Jr, Sr), enter it after the last name and before the first name.
5. Patient's AddressNot Required 
6. Patient's Relationship to InsuredConditionalComplete if the member is covered by a commercial health insurance policy. Place an "X" in the box that identifies the member's relationship to the policyholder.
7. Insured's AddressNot Required 
8. Reserved for NUCC UseNot Required 
9. Other Insured's NameConditionalIf field 11d is marked "YES", enter the insured's last name, first name and middle initial.
9a. Other Insured's Policy or Group NumberConditionalIf field 11d is marked "YES", enter the policy or group number.
9b. Reserved for NUCC Use  
9c. Reserved for NUCC Use  
9d. Insurance Plan or Program NameConditionalIf field 11D is marked "YES", enter the insurance plan or program name.
10a-c. Is patient's condition related to?ConditionalWhen appropriate, place an "X" in the correct box to indicate whether one or more of the services described in field 24 are for a condition or injury that occurred on the job, as a result of an auto accident or other.
10d. Reserved for Local Use  
11. Insured's Policy, Group or FECA NumberConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured's policy number as it appears on the ID card. Only complete if field 4 is completed.
11a. Insured's Date of Birth, SexConditionalComplete if the member is covered by a Medicare health insurance policy.

Enter the insured's birth date using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the insured.
11b. Other Claim IDNot Required 
11c. Insurance Plan Name or Program NameNot Required 
11d. Is there another Health Benefit Plan?ConditionalWhen appropriate, place an "X" in the correct box. If marked "YES", complete 9, 9a and 9d.
12. Patient's or Authorized Person's signatureRequiredEnter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File".

Enter the date the claim form was signed.
13. Insured's or Authorized Person's SignatureNot Required 
14. Date of Current Illness Injury or PregnancyConditionalComplete if information is known. Enter the date of illness, injury or pregnancy, (date of the last menstrual period) using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014.

Enter the applicable qualifier to identify which date is being reported.
431 - Onset of Current Symptoms or Illness
484 - Last Menstrual Period
15. Other Date NotNot Required 
16. Date Patient Unable to Work in Current OccupationNot Required 
17. Name of Referring PhysicianConditional 
17b. NPI of Referring PhysicianRequiredRequired in accordance with Program Rule 8.125.8.A
18. Hospitalization Dates Related to Current ServiceNot Required 
19. Additional Claim InformationConditional 
20. Outside Lab?
$ Charges
ConditionalComplete if all laboratory work was referred to and performed by an outside laboratory. If this box is checked, no payment will be made to the physician for lab services. Do not complete this field if any laboratory work was performed in the office.

Practitioners may not request payment for services performed by an independent or hospital laboratory.
21. Diagnosis or Nature of Illness or InjuryRequiredEnter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition.

Enter applicable ICD-10 code: Z33.1 or Z39.2 depending on the procedure code billed. 
22. Medicaid Resubmission CodeConditionalList the original reference number for resubmitted claims.

When resubmitting a claim, enter the appropriate bill frequency code in the left-hand side of the field.
7 - Replacement of prior claim
8 - Void/Cancel of prior claim
This field is not intended for use for original claim submissions.
23. Prior AuthorizationNot Required

Prior Authorization
Enter the six-character prior authorization number from the approved Prior Authorization Request (PAR). Do not combine services from more than one approved PAR on a single claim form. Do not attach a copy of the approved PAR unless advised to do so by the authorizing agent or the fiscal agent.
24. Claim Line DetailInformationThe paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line.

Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing.

Each claim form must be fully completed (totaled).

Do not file continuation claims (e.g., Page 1 of 2).
24A. Dates of ServiceRequired

The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010119 for January 1, 2019.

FromTo

01

01

19

   

 


Single Date of Service: Enter the six-digit date of service in the "From" field. Completion of the "To" field is not required. Do not spread the date entry across the two fields.

Span billing: Not permitted. All dates of service must have their own detailed line item on the claim. 

24B. Place of ServiceRequired

Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.

02Telehealth Provided Other than in Patient’s Home
03School
04Homeless Shelter
05IHS Free-Standing Facility
06Provider-Based Facility
07Tribal 638 Free-Standing
08Tribal 638 Provider-Based
09Prison/ Correctional Facility
10Telehealth Provided in Patient’s Home
11Office
12Home
19Mobile Unit
20Urgent Care Facility
21Inpatient Hospital
22Outpatient Hospital
23Emergency Room Hospital
25Birthing Center
50Federally Qualified Health Center
53Community Mental Health Center
55Residential Treatment Facility
57Non-residential Substance Abuse Treatment Facility
71State-Local Public Health Clinic
72Rural Health Clinic

 

24C. EMGConditionalEnter a "Y" for YES or leave blank for NO in the bottom, unshaded area of the field to indicate the service is rendered for a life-threatening condition or one that requires immediate medical intervention.

 

24D.Procedures, Services, or Supplies

 

RequiredEnter the HCPCS procedure code that specifically describes the service for which payment is requested. Either T1032 or T1033. 
All procedures must be identified with codes in the current edition of Physicians Current Procedural Terminology (CPT). CPT is updated annually.

HCPCS Level II Codes
The current Medicare coding publication (for Medicare crossover claims only).

Only approved codes from the current CPT or HCPCS publications will be accepted.

 
24D. ModifierConditional

Enter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form.


FQ - The service was furnished using audio-only communication technology.


FR - The supervising practitioner was present through two-way, audio/video communication technology. 


93 - Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive -Audio-Only

 

95 - Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

 

24E. Diagnosis PointerRequiredEnter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis.

At least one diagnosis code reference letter must be entered.

When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow.

This field allows for the entry of 4 characters in the unshaded area.
24F. $ ChargesRequiredEnter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.

Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply.

The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed.

Submitted charges cannot be more than charges made to non-Health First Colorado-covered individuals for the same service.

Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges.
24G. Days or UnitsRequiredEnter the number of services provided for each procedure code.
Enter whole numbers only- do not enter fractions or decimals.


 
24H. EPSDT/Family PlanConditionalEPSDT (shaded area)
For Early & Periodic Screening, Diagnosis, and Treatment related services, enter the response in the shaded portion of the field as follows:
AV - Available- Not Used
S2 - Under Treatment
ST - New Service Requested
NU - Not Used

Family Planning (unshaded area)
If the service is Family Planning, such as for contraception or sterilization, enter "Y" for YES or "N" for NO in the bottom, unshaded area of the field.
24I. ID QualifierNot Required 
24J. Rendering Provider ID #RequiredIn the shaded portion of the field, enter the NPI of the Health First Colorado doula provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic.
25. Federal Tax ID NumberNot Required 
26. Patient's Account NumberOptionalEnter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment?RequiredThe accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program.
28. Total ChargeRequiredEnter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
29. Amount PaidConditionalEnter the total amount paid by Medicare or any other commercial health insurance that has made payment on the billed services.

Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
30. Rsvd for NUCC Use  
31. Signature of Physician or Supplier Including Degrees or CredentialsRequiredEach claim must bear the signature of the enrolled provider or the signature of a registered authorized agent.

Each claim must have the date the enrolled provider or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016.

Unacceptable signature alternatives:
Claim preparation personnel may not sign the enrolled provider's name.
Initials are not acceptable as a signature.
Typed or computer printed names are not acceptable as a signature.
"Signature on file" notation is not acceptable in place of an authorized signature.
32. Service Facility Location Information
32a- NPI Number
32b- Other ID #
RequiredEnter the name, address and ZIP code of the individual or business where the member was seen or service was performed in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.
33. Billing Provider
Info & Ph #
RequiredEnter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
33a- NPI NumberRequired 
33b- Other ID # If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.

Back to Top

CMS 1500 Doula Claim Example

Example of a filled claim form for Doulas

 

Back to Top

Timely Filing

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.

Back to Top

 

Doula Billing Manual Revision Log

Revision Date

Addition/Changes

Made by

8/9/2024Creation of ManualHCPF

 

Back to Top

#FFFFFF
#FFFFFF
#FFFFFF