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Doula Services

A doula or birth worker is a trained professional who provides emotional, physical and informational support services during the prenatal, labor and delivery, and postpartum periods. Doulas are non-clinical and do not provide medical care.

Services should not replace the services of other licensed and trained medical professionals including, but not limited to, physicians, physicians assistants, advanced practice registered nurses, and certified nurse midwives.

Who Qualifies for this Service?

  • All TXIX, CHIP, expansion adult, and Soon-to-be-Sooners (STBS) members who are pregnant or within the postpartum period are eligible for doula services.

What Services Do Doulas Provide?

  • Emotional/physical support and person-centered, culturally competent care
  • Prenatal counseling and assisting in preparing for and carrying out birth plans
  • Teaching and advocating on behalf of the birthing parent during appointment visits
  • Facilitating and assuring access to resources that can improve birth-related outcomes
  • Ongoing education with an emphasis on postpartum care and resources
  • Supporting the whole birth team including a birthing parent’s partner, family members and other support persons.

What Qualifications Must Doulas Have?

Doulas must:

  • Be eighteen (18) years of age
  • Have a National Provider Identifier (NPI)
  • Use the taxonomy number required by the state

Doulas must possess one (1) of the following certifications:

  • Birth doula
  • Postpartum doula
  • Full-spectrum doula
  • Community-based doula

Doulas must be certified by one (1) of the recognized certifying organizations:

What Procedures are Covered Under Doula Services?

Prenatal Visit Billing Codes:

  • 59899/HD - Other Maternity Care and Delivery Procedure

Labor & Delivery Care Billing Codes:

  • 59409/HD - Vaginal Delivery Only (with or without episiotomy and/or forceps)
  • 59514/HD - Cesarean Delivery Only
  • 59612/HD - Vaginal Delivery After Previous Cesarean Delivery
  • 59620/HD - Cesarean Delivery Following Vaginal Delivery Attempt After Previous Cesarean Delivery

Postpartum Visit Billing Codes:

  • 59899/HD - Other Maternity Care and Delivery Procedure

Prenatal and Labor & Delivery Care Diagnosis Codes:

  • Z32.2 – Encounter for Childbirth Education

Postpartum Diagnosis Codes:

  • Z32.3 – Encounter for Childcare Instruction

What are the Service Limitations and Conditions?

  • Eight (8) prenatal/postpartum visits and 1 labor & delivery visit
  • Referral Form from an obstetrician, certified nurse midwife, physician, physician assistant, or certified nurse practitioner
  • Services must be provided in office, hospital, home or in the community
Last Modified on Jun 06, 2024