Medicaid doula billing in New York

1. 1

   Check you meet New York’s doula qualifications

   New York’s requirements differ from other states’ (California’s training pathway is 16 hours, for example). To enroll you need:

   • An NPI, and to be 18 or older.
   • Current adult and infant CPR certification.
   • Current doula-specific liability insurance.
   • The electronic NYS Medicaid Fee-for-Service Doula Directory form, completed.
   • Familiarity with HIPAA.

   Plus one of two pathways:

   Training Pathway

   At least 24 hours of training: 20 hours on core competencies (anatomy of pregnancy and childbirth, labor support and comfort measures, common medical interventions, prenatal and postpartum education, lactation and infant feeding, scope of practice) and 4 on broader ones (cultural humility, health equity, person-centered and trauma-informed care, community resources). Send your certificate(s) or a letter from the training organization, and attest to the training and to support at three or more births.

   Work Experience Pathway

   Attest to support at 30 births or 1,000 hours of doula work (paid or volunteer) in the last ten years, attest to your prenatal, labor and postpartum skills, and send three recommendations on the Department of Health’s client and professional forms (from clients you served, or professionals who saw your doula work, such as a physician, midwife, behavioral health provider, doula or community organization leader).

2. 2

   Enroll with NYS Medicaid in the Provider Services Portal

   Apply through eMedNY’s Provider Services Portal (PSP); the doula provider type is category of service 0464, and there’s no application fee. Upload the documents for your pathway, plus the Doula Attestation form. Two deadlines to watch: an application you start but don’t submit is deleted after 45 days, and if the state asks for more information, you have 45 days to respond before the application is withdrawn.

   Working in a group? Every doula in it must be enrolled individually. A doula-only group or a multi-professional group enrolls with its own group NPI (also no fee for doula-only groups) and must tell Medicaid right away about members joining or leaving, ownership changes and new locations. A doula who leaves without notifying Medicaid stays liable for the group’s claims under their number.

   Questions go to the eMedNY Call Center, 1-800-343-9000.

3. 3

   Contract with the managed care plans your clients use

   From March 2024 to March 2025 every doula claim went to fee-for-service Medicaid. Since April 1, 2025, doula services are part of the managed care benefit package: for a member in a Medicaid managed care plan, you bill that plan, under your contract with it. You still bill eMedNY for members in fee-for-service.

   • Enroll with fee-for-service Medicaid first; plans only contract doulas who are enrolled.
   • Then apply to join each plan’s doula network. eMedNY’s managed care information document lists plan contacts.
   • For a member you started serving before April 1, 2025, the plan had to continue your care at no less than the fee-for-service rate until 12 months after the pregnancy, even if you weren’t contracted.
   • For anyone else, the plan pays only if you’re enrolled, contracted with that plan, and bill the plan.

   Run an eligibility check before the first visit: it shows whether the member is fee-for-service or in a plan, and which plan.

4. 4

   Know when you need a recommendation

   Doula services are a preventive service, which federal rules say must be recommended by a licensed practitioner. Since June 10, 2024, the New York State Commissioner of Health’s standing order fills that requirement, so members don’t need an individual recommendation. If you collect one anyway (or for services before that date), it must include the member’s name and date of birth, the practitioner’s name and license number, the date, and the practitioner’s signature; the state’s form in the policy manual has all of them.

5. 5

   Follow the visit rules

   • Perinatal visits (up to eight): at least 30 minutes of direct interaction with the member, in person or by telehealth under the state’s telehealth policy. No-shows aren’t reimbursable.
   • Labor and delivery (one): in person, except in extenuating circumstances such as illness or a precipitous birth, and a licensed perinatal provider must be in attendance for you to be paid.
   • One visit per day, except that a perinatal visit and the labor and delivery encounter can fall on the same day.
   • Coverage runs through 12 months after the pregnancy ends, whatever the outcome. A new pregnancy within that time starts a new allowance; unused visits don’t carry over.
   • Not covered: group classes, childcare, shopping, placenta encapsulation, vaginal steams, photography, birthing ceremonies, licensed services such as case management, and anything without direct engagement with the member.
6. 6

   Bill the claim

   • Codes: T1032 for each perinatal visit, with Z32.2 for a prenatal visit or Z32.3 for a postpartum visit; T1033 for labor and delivery, with Z32.2.
   • Units: enter 1. Add the place of service (for example 12 for the member’s home).
   • Group billing: enter the group’s Medicaid provider ID and the Medicaid ID of the doula who provided the service (and the service location if the group has several). Payment goes to the group.
   • Interpreters: a third-party interpreter vendor’s services bill as T1013 (one unit for 8–22 minutes, two for 23 or more). You can’t bill for interpreting yourself.
   • Timely filing: follow eMedNY’s timely billing rules (claims are generally due within 90 days of the date of service; eMedNY explains the exceptions). For managed care members, the plan’s contract sets the limit.
   • Medicaid payment is payment in full: no balance billing, no upgrade fees, and no charging members for your travel.

   New York’s diagnosis rules aren’t California’s: here Z32.3 marks a postpartum visit. If you also bill Medi-Cal, keep the two sets separate (our Medi-Cal cheat sheet has California’s).

7. 7

   Document every visit and revalidate every five years

   Keep a record for each member with the date, time and duration of every service and a description that supports the time you billed. The state audits doula claims and can recover payments that aren’t supported.

   Enrollment lasts five years. When eMedNY’s letter asks you to revalidate (don’t send it before then), you’ll attest to six hours of annual continuing education in the doula competencies and show current CPR and doula-specific liability coverage. There’s no revalidation fee.

This guide summarizes New York State 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.