For doulas billing Medi-Cal
Medi-Cal doula billing cheat sheet
Every code, the diagnosis codes each one needs, the modifiers, and the visit limits, from the Medi-Cal Provider Manual on one page. Bookmark it, or print it (Ctrl/Cmd + P).
Source: Medi-Cal Provider Manual, Part 2 – Doula Services, checked October 2026. Plans and DHCS update their rules; check the current manual and your plan’s guide.
What one recommendation covers
- 1initial visit (90 minutes, Z1032)
- Up to 8more visits, any mix of prenatal and postpartum
- 1labor and delivery (incl. stillbirth), abortion or miscarriage support
- Up to 2extended postpartum visits of 3 hours (T1032)
Up to 9 more postpartum visits (Z1038) need a second written recommendation from a licensed provider. That one can’t come from a standing order. Services can run up to 12 months after the end of the pregnancy.
Codes and the diagnoses each one needs
| Code | Service | Diagnosis (one of) | Limit |
|---|---|---|---|
| Z1032 | Extended initial visit (must be 90 minutes) | Z32.2, Z32.3, Z39.1, Z39.2 | Part of the initial package: 1 initial visit |
| Z1034 | Prenatal visit | Z32.2, Z32.3 | Counts toward the 8 additional visits |
| Z1038 | Postpartum visit | Z39.0, Z39.1, Z39.2 | Counts toward the 8; up to 9 more with a second recommendation |
| T1032 | Extended postpartum support, per 15 minutes | Z39.0, Z39.1, Z39.2 | Visit of at least 3 hours: up to 12 units, up to 2 visits (24 units) per pregnancy, on separate days |
| 59409 | Labor and delivery support: vaginal delivery | Z33.1, Z39.0 | One labor and delivery code per pregnancy |
| 59612 | Labor and delivery support: vaginal birth after cesarean | Z33.1, Z39.0 | One labor and delivery code per pregnancy |
| 59620 | Labor and delivery support: cesarean | Z33.1, Z39.0 | One labor and delivery code per pregnancy |
| T1033 | Support during or after miscarriage | Z33.1 | Once per pregnancy; pregnancy must have been confirmed by a licensed provider |
| 59840 | Support during or after abortion | Z33.1 | Once per pregnancy; an abortion service must be documented |
Every line also gets modifier XP.
Claim rules that cause most rejections
- Add modifier XP to every line. It marks the service as performed by a separate practitioner from the medical provider.
- Telehealth: add 93 for audio-only, 95 for video.
- Every line needs one of the diagnosis codes allowed for its procedure code (table above). They describe the service, not a medical diagnosis.
- One visit per day per member, and only one doula may bill a visit for that member that day.
- Exception: one prenatal or postpartum visit may be billed on the same day as labor and delivery, abortion or miscarriage support, and it may be billed by a different doula.
- No place-of-service restrictions.
- Fee-for-service: check the member’s Medi-Cal eligibility for the month of service. Claims must come from an enrolled doula or enrolled doula group.
- Managed care members: you must be contracted with (or have an arrangement with) the member’s plan. You can contract with several plans.
The six diagnosis codes
- Z32.2
- Encounter for childbirth instruction
- Z32.3
- Encounter for childcare instruction
- Z33.1
- Pregnant state, incidental
- Z39.0
- Care and examination of mother immediately after delivery
- Z39.1
- Care and examination of lactating mother
- Z39.2
- Routine postpartum follow-up
What to document
- The date, and the time or duration of each service.
- What you did, in a sentence that supports the time. For example: “Discussed childbirth education with member and developed a birth plan for 1 hour.”
- The written recommendation: a note in the member’s record, a standing order from a plan or provider group, or the signed DHCS form the member gives you.
Not covered by Medi-Cal
Traditional belly binding, birthing ceremonies (such as closing the bones), babywearing classes, massage, photography and video, placenta encapsulation, shopping, vaginal steams and yoga. Doula services also never include medical advice, diagnosis or clinical exams.
Who can enroll as a Medi-Cal doula
At least 18, adult/infant CPR certification, basic HIPAA training, plus one of these:
Training pathway
At least 16 hours of training (lactation support, childbirth education, anatomy of pregnancy and childbirth, comfort measures and labor support, a community resource list) and support at 3 or more births.
Experience pathway
At least 5 years of doula work in the past 7, and 3 letters (testimonials or recommendations) from the past 7 years, one from a licensed provider, community organization or enrolled doula.
Then 3 hours of continuing education every 3 years.
This summary is for convenience and is not billing or legal advice. Medi-Cal managed care plans can publish their own billing guides; follow your contract and the current Provider Manual.