Medicaid doula billing in New Jersey

1. 1

   Complete an approved doula training

   New Jersey approves specific trainings. The Department of Health lists New Jersey programs (Children’s Home Society AMAR, the Department of Health’s Uzazi Village training offered in Trenton, Camden and Newark, and Partnership for Maternal & Child Health of Northern New Jersey) and accepts some others with additional community training:

   • Ancient Song Labor Doula Certification.
   • HealthConnectOne Community Based Doula Training or Uzazi Village Perinatal Doula Training, if completed outside New Jersey.
   • CAPPA Labor Doula or DONA International Birth Doula certification. Postpartum doula certifications aren’t approved.

   Approved trainings cover perinatal education, birth plans, continuous labor support and infant feeding, plus person-centered and trauma-informed care, HIPAA and adult/infant CPR.

2. 2

   Take the Supplemental Community Competency Training

   On top of your doula training, New Jersey requires its Supplemental Community Competency Training (SCCT). Email the Department of Health’s Doula Guides at Doulas.FHS@doh.nj.gov for access. The Doula Guides also help with enrollment questions one on one.

3. 3

   Enroll as a fee-for-service provider

   All NJ FamilyCare doulas must enroll in fee-for-service and be ready to serve fee-for-service members; managed care plans can’t add you until the state confirms that enrollment. You need to be:

   • 18 or older.
   • Cleared by a NJ State Police fingerprint-based background check through DHS’s Central Fingerprint Unit, at no cost to you.
   • Insured for liability of at least $1,000,000 per incident and $3,000,000 aggregate.

   Download the Doula Provider Enrollment Application from njmmis.com (Provider Enrollment Application, then the provider type). There are three versions: an individual doula, a doula-only agency (a business entity of doulas, no clinical supervisor required), and an addendum to affiliate with an existing group such as an OB, midwifery practice or clinic. Doulas in a group still enroll individually and can leave, join another group or bill on their own. Enrollment questions: the Gainwell Technologies Provider Enrollment Unit at 609-588-6036.

4. 4

   Contract with each NJ FamilyCare managed care plan

   The Department of Health lists five managed care organizations to contract with:

   • Aetna Better Health of New Jersey
   • Fidelis Care
   • Horizon Blue Cross Blue Shield (Horizon NJ Health)
   • UnitedHealthcare Community Plan
   • Wellpoint

   Managed care claims use the same doula codes as fee-for-service, but rates may differ. To be paid for a plan’s member, you need to be enrolled with that plan.

   Horizon NJ Health’s doula policy (revised February 2026) gives a 365-day claim deadline and won’t pay a doula code without the HD modifier and Z32.2. Check each plan’s deadline in your contract.

5. 5

   Follow the visit rules

   • Recommendation: the state’s guidance requires a licensed practitioner’s recommendation (physician, midwife, nurse or other licensed practitioner) on file before you start care.
   • Initial visit first: the longer initial prenatal visit must be billed before other visits. If a doula-member match doesn’t work out, a new doula can bill a new initial visit.
   • Limits per doula: the 8-visit (or 12-visit) limit applies to each doula-member pair, so visits with a first doula don’t count against a second.
   • One visit per day, except a prenatal visit and the delivery, or the delivery and a postpartum visit, on the same day.
   • Services happen in the community, at a clinician’s office when accompanying the member, or in the hospital. Doulas can’t transport members.
   • How long: the state’s 2021 newsletter covers doula care from pregnancy to 180 days postpartum, while the member stays eligible. NJ FamilyCare has since extended postpartum coverage to 365 days, so confirm the current doula window with your plan or the Doula Guides.
6. 6

   Bill with the HD codes, in 15-minute units

   • Visits bill in 15-minute units up to each code’s maximum (6 units for the initial visit, 4 for others). The delivery is a flat rate, whether vaginal or cesarean, with nothing extra for twins or more.
   • Enhanced care (members 19 or under): the four extra visits use 99600 HD 22 and 99199 HD 22.
   • Diagnosis: Z32.2 on every doula claim.
   • Fee-for-service submission: an electronic 837P, direct data entry on njmmis.com (your enrollment letter has the login), or a CMS-1500. Claims help: Gainwell Technologies, 1-800-776-6334.

   New Jersey’s codes are very different from California’s and New York’s, so keep each state’s rules separate. See the New York guide and the Medi-Cal cheat sheet.

7. 7

   Claim the postpartum incentive

   New Jersey pays an extra incentive when you provide a postpartum visit within six weeks of delivery, bill it as 99199 HD U8, and the member also has an obstetric follow-up visit within six weeks. Your postpartum visit is paid on time regardless; only the incentive depends on the obstetric visit. Encourage clients to book that follow-up.

This guide summarizes NJ FamilyCare (New Jersey Medicaid)’s published doula policy, billing guidelines and fee schedule for convenience and is not billing or legal advice. Rules and rates change; follow the current state manual and your managed care contracts.