Medicaid doula billing in Oregon

1. 1

   Get certified as a THW birth doula

   Oregon Medicaid only enrolls doulas certified by OHA’s Traditional Health Worker (THW) program. Its eleven requirements for new birth doulas:

   • At least 28 contact hours of in-person childbirth education and birth doula training from an OHA-approved program. Online doula courses, midwifery or nursing training don’t substitute.
   • Six contact hours of cultural competency training.
   • One hour of interprofessional collaboration.
   • One hour of HIPAA compliance.
   • Four hours of trauma-informed care.
   • Current CPR certification for children, infants and adults.
   • A 1.5-hour OHA-approved oral health training.
   • A community resource list for the area you serve.
   • Documented attendance at three births and three postpartum visits.

   You apply through Oregon’s Health Workforce Registry (OHA also requires a background check with every renewal). Doulas certified in Alaska or Idaho can apply by reciprocity; OHA paused reciprocity for Washington doulas on February 11, 2026.

2. 2

   Get an NPI and enroll as an OHP provider

   Apply for an NPI on the NPPES site with the doula taxonomy 374J00000X. Then enroll with OHA: on the forms, enter provider type 13, specialty code 600, and attach your NPI and THW certification.

   • A doula billing organization will bill for you: complete form OHP 3113.
   • You’ll bill OHA yourself: complete OHA 3972 and OHA 3975.

   Enrollment questions: OHA Provider Enrollment, 1-800-336-6016 (option 6) or provider.enrollment@odhsoha.oregon.gov.

3. 3

   Work with the CCOs your clients belong to

   OHA’s billing guide covers open card (fee-for-service) members. Most Oregon Health Plan members belong to a coordinated care organization (CCO), and for them OHA sends doulas to the CCO: contact the member’s CCO or its THW liaison about contracting and billing.

   CCOs publish their own doula billing guides and rates. AllCare CCO’s February 2026 guide, for example, uses the same T1033 codes but lists $1,500 for the global code. Check each CCO’s guide before you bill.

4. 4

   Bill the global package after the birth

   The global doula benefit covers four maternity support visits (two before delivery, two after, at the member’s home or alongside an office visit) and your support on the day of delivery. Bill T1033 with modifier HD:

   • Once per pregnancy, and after the day of delivery.
   • On a professional claim, following OHA’s OHP Billing Tips.
   • Check the member’s OHP eligibility and enrollment before you provide services or bill.
5. 5

   Bill partial services when you didn’t do the whole package

   When you provide some but not all of the global package (you met the client late, or the birth happened before you arrived), bill what you did: T1033 with no modifier for each support visit provided (up to two prenatal and two postpartum, $215 each), and T1033 22 for support on the day of delivery only ($645). Bill only one delivery code per patient.

6. 6

   Add up to four more support visits

   OHA pays up to four additional support visits on top of the global package, billed separately as T1033 ($215 each). They can be any mix of prenatal and postpartum visits, up to 12 months after the pregnancy ends. At fee-for-service rates, the global package plus four extra visits comes to $2,365.

7. 7

   Document each encounter and keep records

   Oregon’s rule (OAR 410-130-0015) asks doulas to document each encounter with:

   • The date of service.
   • A brief description of the education or services provided.
   • Any member needs beyond routine care, and any referrals you made.

   For any doula service billed to OHP, the patient’s medical record must include your name and how long you supported the patient during labor and delivery, so coordinate with the birth team. Keep clinical records for seven years and financial records for at least five.

8. 8

   Recertify every three years

   THW certification lasts three years. Renew with at least 20 hours of continuing education from the past three years and a new background check, through the Health Workforce Registry. You can start up to 90 days before your certification expires, and OHA says processing can take six weeks or more; it can’t extend an expiration date, so apply early.

This guide summarizes Oregon Health Plan (Oregon 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.