Medicaid Doula Pilot Program - Coming in 2019

Date Issued: 1/23/2019

EmblemHealth will participate in the New York State Doula Pilot Program. The pilot program is part of the state’s comprehensive initiative to target maternal mortality and reduce racial disparities in health outcomes.

Pregnant women who live in selected zip codes in Kings* (Brooklyn) County will have access to doula services. A doula, also known as a birth companion, birth coach, or post-birth supporter, is trained to provide physical and emotional support to a mother before, during, and after childbirth.

When the pilot program launches, EmblemHealth will cover the following doula services for pregnant Medicaid members residing in the selected zip codes in Kings* County:

  • Up to and including four prenatal visits
  • Support during labor and delivery
  • Up to and including four postpartum visits

Doulas in EmblemHealth’s network must submit claims with the following procedure codes for reimbursement:

Visit Type Procedure Code Max Number of Billable Visits
Prenatal Care Visit 99600 4
Labor and Delivery 99499 1
Postpartum Visit 99600 + UA Modifier 4

Fee Schedule

Service Payment
Prenatal Care Visit $30
Labor and Delivery $360
Postpartum Visit $30

  • The total for 8 visits plus labor and delivery is $600.

* The Doula Pilot Program does not include the following zip codes in Kings County that are already funded through the New York City Department of Health and Mental Hygiene’s By My Side program: 11207, 11212, and 11233.

For more information, visit: https://www.health.ny.gov/health_care/medicaid/redesign/doulapilot/pilot.htm.