Members may be covered for a maximum of eight prenatal doula visits and/or postpartum doula visits and one labor and delivery support visit (vaginal, vaginal birth after cesarean, cesarean birth, and stillbirth). Doulas must be enrolled as New York State Medicaid fee-for-service providers to receive reimbursement according to the following rate structure: Service Visit Allowance Per Visit Reimburse-ment Percentage of Total Reimburse-ment Amount of Total Reimburse-ment Perinatal Service: Prenatal or postpartum doula support Up to eight (8) visits New York City: $93.75 Rest of state: $84.37 50% New York City: Up to $750 Rest of state: Up to $675 Labor and Delivery: In-person doula support during labor and birth One (1) encounter New York City: $750 Rest of state: $675 50% New York City: $750 Rest of state: $675 Billing and coding guidance can be found in the Doula Services Benefit Policy Manual. For more information, see New York State doula services benefit.

Improving Health Outcomes With Doula Services

As of April 1, 2025, EmblemHealth covers doula services in hospital, clinic, and community settings for Medicaid, Health and Recovery Plan (HARP), VIP Dual Enhanced (HMO D-SNP), and Essential Plan members who are pregnant, birthing, and postpartum (for up to 12 months after the delivery date).

EmblemHealth is inviting doulas to join our provider network. If you are interested in partnering with EmblemHealth, please contact medicaidproduct@emblemhealth.com.

We created a training video exclusively for doula providers to help you do business with us. Watch this video to learn about:

Who we are.
How to partner with us.
Our member ID cards.
Billing for doula services.
Resources and helpful links.

You may also download the presentation.

Frequently Asked Questions

Reimbursement for Doula Services

What is covered?

Members may be covered for a maximum of eight prenatal doula visits and/or postpartum doula visits and one labor and delivery support visit (vaginal, vaginal birth after cesarean, cesarean birth, and stillbirth). Doulas must be enrolled as New York State Medicaid fee-for-service providers to receive reimbursement according to the following rate structure:

Service	Visit Allowance	Per Visit Reimburse-ment	Percentage of Total Reimburse-ment	Amount of Total Reimburse-ment
Perinatal Service: Prenatal or postpartum doula support	Up to eight (8) visits	New York City: $93.75 Rest of state: $84.37	50%	New York City: Up to $750 Rest of state: Up to $675
Labor and Delivery: In-person doula support during labor and birth	One (1) encounter	New York City: $750 Rest of state: $675	50%	New York City: $750 Rest of state: $675

Billing and coding guidance can be found in the Doula Services Benefit Policy Manual. For more information, see New York State doula services benefit.

What clearinghouse does EmblemHealth use?

EmblemHealth uses TriZetto. If you already use a clearinghouse, such as Ability, SSI Group, Availity, or Claim Logic, your claims will still be sent to EmblemHealth.

Is Availity Essential Plus required for doulas billing through Availity?

No. Availity Essential Plus is not required for doulas billing through Availity.

Does EmblemHealth require contracted providers to use a specific platform for telehealth visits?

EmblemHealth does not have a specific platform that doula providers are required to use for telehealth visits. Doula should make sure their platform of choice allows both audio and video communication, and that telehealth services are provided via a HIPAA compliant telehealth platform.

JP 69533 9/2025

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