Understanding Doula Billing Procedures for Oregon Health Plan - July 1, 2024
Explore the new billing procedure code T1033 for doula services in Oregon Health Plan, including modifiers HD and 22. Learn why the update is necessary, correct billing and coding details, global billing examples, and support visit billing examples. Questions can be submitted via email for clarification. Visit the link for feedback submission on the new codes.
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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
