Doula Billing Procedure Update for Oregon Health Plan Providers
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Oregon Health Plan Doula Services
Dalila Morales
Medicaid Programs Unit
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On 10/1/2022 Center for Medicare & Medicaid Services (CMS)
added a procedure code for doula services that Oregon Health
Plan must implement.
•
The rule is being updated as a part of implementation of the
new procedure code T1033 and new modifier HD.
–
OAR
410-130-0015, Rule will be updated by April 15,2024
–
A notification will come from OHA on/or after the April
15,2024 when rule is Permanent with the effected date of
July 1,2024 for the new procedure code and modifiers to
be sue.
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Rate
Description
Code
Units does not mean visit, its only for payment purpose
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CMS-1500 Example 1- Global doula benefit this includes
delivery and two prenatal visit and two postpartum visit,
must have modifier HD.
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CMS-1500 Example 2- Doula service day of delivery
only must have modifier 22.
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Please email
dmap.providerservices@oha.oregon.gov
to s
ubmit
questions about this change, process and implementation.
Presentation will be sent out.
Here is the link to where folks can give feedback on the codes to
CMS
https://www.ama-assn.org/practice-management/cpt/code-
change-instructions
8
Understand the new billing procedure for doula services under the Oregon Health Plan, including the new procedure code T1033, modifiers HD and 22, and the importance of the update. Learn about correct billing and coding, global billing examples, and different billing scenarios for doula services. Questions can be directed to dmap.providerservices@oha.oregon.gov. Feedback on the codes can be submitted to CMS through the provided link.
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Presentation Transcript
Doula Billing For July 1, 2024 Oregon Health Plan Doula Services Dalila Morales Medicaid Programs Unit
This session is to help understand the new billing procedure code T1033 (Services performed by a doula birth worker, per diem) , new modifier HD (Pregnant/parenting women s program), and modifier 22 2
Why update is needed On 10/1/2022 Center for Medicare & Medicaid Services (CMS) added a procedure code for doula services that Oregon Health Plan must implement. The rule is being updated as a part of implementation of the new procedure code T1033 and new modifier HD. OAR 410-130-0015, Rule will be updated by April 15,2024 A notification will come from OHA on/or after the April 15,2024 when rule is Permanent with the effected date of July 1,2024 for the new procedure code and modifiers to be sue. 3
Correct billing and coding Description Code Rate T1033 Global doula benefit with HD modifier $1,505.00 $645.00 T1033 Doula Service day of delivery only with 22 modifier $215.00 per visit T1033 Support visit up to 2 prenatal visits and 2 postpartum visits Units does not mean visit, its only for payment purpose 4
Global Billing Example CMS-1500 Example 1- Global doula benefit this includes delivery and two prenatal visit and two postpartum visit, must have modifier HD. 5
Delivery only Billing Example CMS-1500 Example 2- Doula service day of delivery only must have modifier 22. 6
Support visits only Billing Example CMS-1500 Example 3- Doula support visit up to two prenatal visits and two postpartum visits, indicate the number of allow visits. Required NO modifier. Rate of $215 is per visit. 7
QUESTIONS? Please email dmap.providerservices@oha.oregon.gov to submit questions about this change, process and implementation. Presentation will be sent out. Here is the link to where folks can give feedback on the codes to CMS https://www.ama-assn.org/practice-management/cpt/code- change-instructions 8
