What State Medicaid Programs Actually Pay Doulas: A 51-State Verification

No rate exists. Alaska Medicaid publishes 25 provider-type fee schedules (FY2026) and none is a doula schedule. Downloaded the Physician FY2026 (23,366 shared strings) and APRN FY2026 (16,999 shared strings) XLSX files and searched the code/description strings: 'doula' 0 hits, T1032 0 hits, T1033 0 hits, S9445 0 hits, 99199 0 hits, 'labor support' 0 hits, 'birth attendant' 0 hits. POSITIVE CONTROL: 99213 returns exactly 1 hit in BOTH schedules, so the extraction and search method work and the doula zeros are real absences, not a parsing failure.

No rate exists, because no benefit exists. The Alabama Medicaid Agency Administrative Code (Title 560-X) is the authoritative definition of every Alabama Medicaid benefit; its published index runs 64 chapters and NONE is a doula chapter. Downloaded and text-extracted the seven chapters that could plausibly house such a benefit: Chapter 6 Physicians Program (11,387 words), Chapter 21 Nurse Midwife Program (2,040), Chapter 29 Definitions of Terms Used in Rules (2,559), Chapter 37 Managed Care (10,297), Chapter 45 Nurse-Family Partnership (1,384), Chapter 55 Perinatal Coordinators (616), Chapter 64 Integrated Care Networks (8,938). 'doula' returns 0 hits in all seven. POSITIVE CONTROLS on the same extracted text: 'midwife' 35 hits in Chapter 21, 'delivery' 45 hits in Chapter 6, 'matern' 10 hits in Chapter 45, so the PDFs extracted correctly and the doula zeros are real. Independent confirmation from the state's own legislature: pending bill HB598 (2026) is captioned in part 'to require Medicaid and all insurers to cover midwife and doula services', which is direct evidence from an Alabama primary source that Alabama Medicaid does not cover doula services today.

Rates are from the state's OWN published fee schedule, 'Maternal Health Providers and Remote Monitoring Fee Schedule' (DHS, 1 page), read directly. EVERY doula line carries modifier HD; that modifier is what makes the row a doula row. Doula rows: 59899/HD 'Prenatal Other Maternity Care and Delivery Procedure' $64.45; 59409/HD 'Vaginal Delivery Only (with or without episiotomy and/or forceps)' $468.55; 59514/HD 'Cesarean Delivery Only' $325.45; 59612/HD 'Vaginal Delivery After Previous Cesarean Delivery' $527.78; 59620/HD 'Cesarean Delivery Following Vaginal Delivery Attempt After Previous Cesarean Delivery' $546.50; 59899/HD 'Postpartum Other Maternity Care and Delivery Procedure' $64.45. Unit limits come from the Nonclinical Maternal Care provider manual section 210.300 'Covered Benefits - Benefit Limits' (per recipient PER PREGNANCY): up to 4 prenatal visits (at least one including a health-related social needs assessment), exactly 1 visit for attendance at labor and delivery (doula must be physically present during labor, delivery and immediate postpartum), and up to 2 postpartum visits occurring within 16 weeks of delivery. ARITHMETIC: prenatal 4 x $64.45 = $257.80; postpartum 2 x $64.45 = $128.90; fixed non-delivery subtotal $386.70. Add one delivery-attendance rate: VAGINAL (the reported figure) $386.70 + $468.55 = $855.25; cesarean $386.70 + $325.45 = $712.15; VBAC $386.70 + $527.78 = $914.48; cesarean after VBAC attempt $386.70 + $546.50 = $933.20, which is the MAXIMUM possible per pregnancy. CROSS-CHECK: that $933.20 ceiling independently matches the figure repeatedly quoted by public commenters in DHS's own published Public Comment Summary ('The current proposal reimburses a maximum total of $933.20 for prenatal visits, postpartum visits, and birth support'), and DHS's written response declined to change the amounts ('we elected to maintain the structure and amount of the rates we selected'), so the arithmetic reproduces the state's own number exactly. Arkansas DOES cap per pregnancy, via visit limits rather than a dollar cap; the effective ceiling is $933.20. MODIFIER TRAP: base codes 59409, 59514, 59612 and 59620 without /HD are PHYSICIAN delivery rates and are many times higher; the doula figures above are only valid with the HD modifier, on the doula section of the doula fee schedule.

AHCCCS PUBLISHES COMPONENT RATES BUT DELIBERATELY PUBLISHES NO PER-PREGNANCY BUNDLE CAP, so no honest single per-birth total can be derived from Arizona's own documents. Component rates, read directly from the AHCCCS 'FFS Program Capped Fee Schedule, Final Doula Fee Schedule, Effective 10/1/2025' XLSX (FY26_FinalDoulaRates.xlsx, parsed from xl/sharedStrings.xml): (1) T1032 'Services performed by a doula birth worker, per 15 minutes' = $16.28 per 15-minute unit; (2) T1033 'Services performed by a doula birth worker, per diem' = $781.32 per diem. Both rates are UNCHANGED from the original 10/1/2024 schedule (FinalDoulaRatesEff10012024.xlsx), i.e. Arizona has not raised doula rates since launch. Claim-level limits, from the AHCCCS Doula FAQ (Q6): T1032 is limited to 2 hours (8 units, = $130.24) and T1033 to 'once per day, once every 9 months'; the FAQ adds that 'These limits may be exceeded, based on medical necessity, through Prior Authorization.' THE DECISIVE LANGUAGE is AMPM Policy 410 (Maternity Care Services), Chapter 400, section on Doulas, subsection iv, verbatim: 'There is no minimum or maximum number of visits required.' Policy 410 also bars contractors from requiring prior authorization for a pregnant or postpartum member to receive doula services, deems medical necessity automatically met for any pregnant or up-to-one-year-postpartum member, and states doula services 'are separately reimbursable and are not included in the global OB bundle.' Consequently the only amount Arizona caps on a per-pregnancy basis is T1033 at once every 9 months = $781.32, which is birth-attendance-equivalent alone and must NOT be published as Arizona's bundle. For scale only, and explicitly NOT an Arizona figure: a course comparable to other states' 8 visits plus birth would be 8 x $130.24 + $781.32 = $1,823.24; that 8 is our assumption, not AHCCCS's, so it is recorded here and not in the rate field.

CAPPED. DHCS publishes its own per-pregnancy maximum, so this is not a reconstructed number. Standing recommendation authorizes: 1 initial visit + up to 8 combined prenatal/postpartum visits + labor and delivery support + up to 2 extended three-hour postpartum visits. Current TRI rates (effective 2024-01-01): Z1032 extended initial visit 90 min $197.98 x 1 = $197.98; Z1034 prenatal or postpartum visit $162.11 x 8 = $1,296.88; CPT 59409 support during vaginal delivery $685.07 x 1 = $685.07; T1032 extended postpartum visit (15-min unit, 12 units per visit) $486.36 x 2 = $972.72. TOTAL = $3,152.65. DHCS Figure 2 prints exactly $3,152.65 for 'All initial recommendation visits and support during vaginal delivery', confirming the arithmetic. Delivery-mode variants: 59612 VBAC bundle $3,236.27; 59620 caesarean bundle $3,263.31. Miscarriage/abortion support (T1033 / 59840, $250.85, once per pregnancy) substitutes for delivery rather than adding. A SECOND physician recommendation unlocks Z1038 additional postpartum visits, $162.11 x 9 = $1,458.99 more, raising the ceiling to $4,611.64; that is gated on a separate recommendation and is not part of the standing bundle. Pre-TRI (2023) legacy rates yielded $1,514.87 for the same vaginal-delivery bundle.

Colorado publishes an explicit per-pregnancy cap. Doula Billing Manual, Covered Doula Services: 'Covered services are limited to 180 minutes of prenatal care and 180 minutes of postpartum care per member, and one instance of labor and delivery per member pregnancy during a 12-month period regardless of the number of doula providers who treat that member.' The manual's Coding Table restates it as 12 units of T1032 prenatal + 12 units of T1032 postpartum + 1 unit of T1033, and adds that a member and doula 'cannot distribute that amount differently'. Rates from the CURRENT Health First Colorado Fee Schedule, tab 'Fee Schedule 07-1-2026', column 'Total Allowable Amount 07-01-2026 Rates': T1032 (doula birth worker services, per 15 minutes, timed) = $24.50 per unit; T1033 (doula birth worker services, per delivery, untimed, once per member per delivery) = $882.00. Arithmetic: prenatal 12 x $24.50 = $294.00; postpartum 12 x $24.50 = $294.00; labor and delivery $882.00. Total = $1,470.00. Internal check: T1033 is priced at exactly 36 x the T1032 unit rate in every published version of the schedule (914.40/25.40, 900/25, 882/24.50), so these are deliberate rate settings, not transcription noise.

CAPPED AT THE STANDARD BUNDLE, WITH A PRIOR-AUTHORIZATION TAIL. Per Provider Bulletin PB2025-14 / Policy Transmittal 2025-03, HUSKY Health members are eligible to receive up to four (4) TOTAL antepartum or postpartum visits (combined, in any mix), plus one (1) visit specific to the doula's attendance at labor and delivery. Rates from the official CT doula fee schedule (refw242_feesched_doula_95.csv, header 'Doula - 1/1/2025'): T1033 'Services performed by a doula birth worker, per diem', no modifier, Max Fee $100.00, effective 01/01/2025 through 12/31/2299; T1033 with modifier HD (PREGNANT/PARENTING PROGRAM) 'specific to attendance at birth', Max Fee $800.00, same effective span. Arithmetic: (4 x $100.00) + $800.00 = $1,200.00. The $800 is an explicit FLAT FEE for the whole labor and delivery, not a per-hour or per-diem accrual, and the doula must be present in person for the duration. IMPORTANT QUALIFIER: visits BEYOND the four require prior authorization for medical necessity, reviewed by Community Health Network of CT (CHNCT), and the bulletin sets NO numeric ceiling on how many additional visits may be authorized. So $1,200 is the maximum billable WITHOUT prior authorization, and CT publishes no absolute per-pregnancy dollar cap above it. Only two codes exist on the entire CT doula fee schedule; there is no separate miscarriage, abortion, bereavement, or extended-visit code.

CURRENT RATES, DHCF Transmittal 25-36 (dated 2025-12-29), effective 2026-01-01 through 2026-12-31, a 2.7% increase over CY2025 per the SPA approved by CMS 2022-09-28. Codes verbatim from the transmittal rate table: (1) 99600-HD 'Perinatal Doula Support Visit' = $107.89 per visit (billed per visit regardless of length); (2) 59400-HD 'Doula Support at Delivery - Vaginal Delivery' = $762.98, 59514-HD 'c-section' = $762.98, 59612-HD 'V-BAC' = $762.98 (one delivery-attendance claim per birth, all three priced identically); (3) 99199-HD 'Postpartum Doula Support - 15 Minute Increment' = $13.48 per 15-minute unit, capped at 24 units / 6 hours per postpartum visit; (4) 99199-HD-U8 'Doula Incentive Payment for Obstetric Postpartum Visit 7 to 84 Days After Labor and Delivery' = $100.00, payable once when the doula performs at least one postpartum visit AND the client is seen by an obstetric clinician for a postpartum visit after a delivery claim. UNIT LIMIT (SPA Attachment 4.19-B and Transmittal 22-34): 'a total of twelve (12) visits per beneficiary across the perinatal and the postpartum period,' INCLUDING attendance at delivery and including a maximum of one doula consultation. DC does not fix the split between perinatal and postpartum visits, so the bundle total is a RANGE, not a single published number. Recorded value = the standard full-course reading: 1 delivery ($762.98) + the remaining 11 visits billed as perinatal per-visit ($107.89 x 11 = $1,186.79) + the $100.00 postpartum incentive = $2,049.77, rounded to $2,050. CEILING if all 11 non-delivery visits were billed as postpartum visits at the maximum 24 units each: $762.98 + (11 x 24 x $13.48 = $3,558.72) + $100.00 = $4,421.70. A realistic mixed course (8 perinatal visits + delivery + 3 maxed postpartum visits + incentive) = $2,696.66. Every figure in this range is many multiples of our stored $900. Prior-year rates for reference: CY2025 (Transmittal 24-34) 99600-HD $105.05 / delivery $742.92 / 99199-HD $13.13; original CY2022 launch rates (Transmittal 22-34) 99600-HD $97.04 / delivery $686.23 / 99199-HD $12.13 / incentive $100.00.

Delaware's State Plan defines the bundle but delegates dollar amounts to a fee schedule. Per approved SPA 24-0001 / 25-0002 Attachment 4.19-B p.8, the covered bundle is: up to 3 prenatal visits (minimum 1), labor/birth attendance, and up to 3 postpartum visits within 90 days of delivery without a licensed-provider recommendation form, extendable to 8 postpartum visits within 180 days with a Title 24 practitioner recommendation, and beyond 8 on medical necessity. Visits bill in 15-minute increments with a maximum of 6 units (90 minutes) per visit. Birth attendance is a flat rate 'determined by the State.' A separate incentive payment is paid after the third postpartum visit if the doula completed all 3 prenatal visits, attended the birth, and completed all 3 postpartum visits for the same member. Multiple births (twins, triplets) earn no additional reimbursement. The reimbursement window runs from confirmed conception through 180 days postpartum. So the benefit IS bundle-capped, but the per-unit and flat-rate dollar values live on the DMAP fee schedule, which the SPA cites at http://www.dmap.state.de.us/downloads.html. That host is dead (connection failure) and its successor, the Delaware Medical Assistance Portal downloads page, is behind a session-token/JS gate that returns the portal home page to a non-browser client. Total per birth therefore not computable from any source I could confirm live. NOT reported as uncapped: the cap exists, only the dollar values are unretrievable.

No rate exists. The 2026 Florida Medicaid Practitioner Fee Schedule (154 pages, effective 2026) contains zero occurrences of 'doula' and zero occurrences of the HCPCS codes states typically use for doula services (T1032, T1033, S9445, 99199). POSITIVE CONTROL: the same schedule pays 99213 at $34.29 (line 7351, and the policy narrative at line 63 confirms '99213 = 1 unit at $34.29'), so the document and the search are working. AHCA publishes no doula fee schedule at all: the full 2026 fee-schedule index lists Birth Center, Licensed Midwife, Practitioner, RPICC Neonatal and 30 others, but no doula schedule. Rule chapter 59G-4 (Medicaid Policy, ~60 service-specific rules) contains no doula rule.

No rate exists. Georgia Medicaid enumerates its provider types as policy manuals, one per billable provider category, and publishes the complete list (150+) on the GAMMIS portal. The alphabetical listing runs '...Dialysis Services (07/01/2026) / Durable Medical Equipment (07/01/2026)...' with no Doula manual in the gap where one would sort. There is likewise no doula fee schedule: the complete GAMMIS fee-schedule directory contains Anesthesia, DME, Lab Max Allowable, Orthotic & Prosthetic, Outpatient Site of Service, Physician Fee Schedule (+ Enhanced Rate Crosswalk), Provider Administered Drug List and quarterly zipped bundles, and nothing for doulas. With no provider manual and no provider category, a doula cannot enroll in Georgia Medicaid and therefore cannot bill.

No rate exists. Downloaded Hawai'i's CURRENT Medicaid Fee-for-Service Fee Schedule (the file MQD itself labels 'Current Medicaid Fee-for-Service (FFS) Fee Schedule', dated 20260601, 313 pages, 183,141 words) and searched it: 'doula' 0 hits, T1032 0 hits, T1033 0 hits, 'birth support' 0 hits. Two codes some states use for doula work DO appear but are explicitly NOT payable: S9445 'PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER' is listed at 0, and 99199 'OTHER SPECIAL SERVICE, PROCEDURE, OR REPORT' is listed at $0.00. POSITIVE CONTROL: 99213 'ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT' returns a real rate of $65.05 on the same extracted text, so the schedule parsed correctly and the doula zeros are genuine. WRONG-ROW TRAP AVOIDED: 59409 'VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS)' does appear at $748.94, but that is the PHYSICIAN delivery rate on the physician schedule with no doula modifier and no doula provider type behind it; it is not doula pay and must not be reported as such.

No rate exists. Iowa Medicaid has no doula provider type, no doula service definition, and no doula procedure code. The only dollar figure ever attached was a $220,000 FY2026 General Fund aggregate appropriation proposed by the Governor to establish the benefit; it was struck before enactment and never became a fee-schedule rate.

No rate exists. Idaho Medicaid has no doula benefit, so there is no fee-schedule line, no procedure code, and no per-birth reimbursement to derive.

Source: HFS 'Fee Schedule For Doulas', effective 05/01/2026, updated 05/05/2026 (doulafs05012026.pdf). Components with a PER-PREGNANCY cap: 59409 Labor & Delivery Support, Vaginal Delivery Only, $720.00, 1 unit per pregnancy (also 59514 Cesarean $720.00, 59612 VBAC $720.00, 59620 Cesarean after attempted VBAC $720.00, each 1 unit per pregnancy and mutually exclusive, so exactly one $720 birth-attendance unit is payable per pregnancy); 59430 Postpartum Visit attendance with practitioner, $50.00 per unit, max 2 units per delivery = $100.00; 99381 Initial Newborn Visit facilitation and attendance, $50.00, 1 unit per child = $50.00. Sum of per-pregnancy-capped components = 720 + 100 + 50 = $870.00. Components with NO per-pregnancy cap (daily cap only, so no bundle total can be computed): S9445 Non-physician Prenatal Patient Education, $15.00 per 15-min unit, DAILY max 8 units = $120.00/day, no stated per-pregnancy limit; S9444 Postpartum Parenting Education/Advocacy/Connection to Resources, $15.00 per 15-min unit, DAILY max 16 units = $240.00/day, no stated per-pregnancy limit; S9445-HQ and S9444-HQ group sessions $5.00 per 15-min unit, daily max 8 units = $40.00/day; T1032 doula support during or after miscarriage or abortion, $15.00 per 15-min unit, daily max 8 units = $120.00/day (loss pathway, not part of a live-birth bundle). Because prenatal and postpartum education are capped only per DAY and never per pregnancy, Illinois publishes no maximum total per birth and none can be derived; $870 is the sum of every component the state caps per pregnancy, i.e. a floor for a full-bundle birth, not a published bundle total.

The rate is affirmatively zero, not merely absent. The IHCP Professional Fee Schedule (the state's own published master fee file, 37,423 rows) DOES carry both national doula HCPCS codes, and prices them at nothing: T1032 'SV DOULA BRTH WRK PER 15 MIN' - coverage category 82 'Non Covered Services', pricing source SYSMAN, effective 10/01/2022, max fee 0.00 / 0.00, no end date; T1033 'SV DOULA BRTH WRK PER DIEM' - identical, coverage category 82 'Non Covered Services', effective 10/01/2022, max fee 0.00 / 0.00, no end date. POSITIVE CONTROL from the same file: 99213 'OFFICE O/P EST LOW 20 MIN', coverage category 285 'Medical Services', RBRVS-priced, effective 01/01/2026, max fee $83.88 (physician) / $60.62, so the file, the parse and the search are all sound. Those two rows are the only occurrences of 'doula' in the entire fee schedule. A code that is listed as Non Covered at $0.00 is the strongest possible form of a negative: Indiana has explicitly considered these codes and declined to pay them.

KDHE testimony to the Bethell Joint Committee: T1032 prenatal 28 x 15-min units at $15 = $420, plus T1033 delivery flat $500, plus T1032-TS postpartum 25 x 15-min units at $15 = $375. Total $1,295.

8 visits x $69.69 (S9445) = $557.52, plus 1 delivery attendance (99199) at $459.00 = $1,016.52. Read from the official Professional Services Fee Schedule, TOS 66, fee effective 20260101. Provider manual sets 99199 at 1 per pregnancy and pools S9445/S9442/S9443/S9444 into 8 allowable visits.

101 CMR 319.03(2): code 99600 perinatal visit $100 (or $150 with modifier TF for 61-90 min), and 99199 labor and delivery support $900, limited to 1 per perinatal period per 130 CMR 463.409(B). Verified bundle $800 + $900 = $1,700.

CAPPED, and like California the state publishes its own maximum, so this is not reconstructed. Maryland uses the '8:1 model': coverage for up to eight (8) perinatal visits in ANY combination of prenatal and postpartum, plus one attendance at labor and delivery. Each perinatal visit is up to 60 minutes billed as four 15-minute units. Rates as of 7/1/23: T1032 prenatal service visit $16.62 per 15-min unit x 4 units = $66.48 per visit; T1032 with modifier U9 postpartum service visit $19.62 per 15-min unit x 4 units = $78.48 per visit; T1033 attendance at delivery, FLAT $800, 1 unit per delivery. Because postpartum pays more per unit than prenatal, the bundle total is a RANGE, not a single number, and it depends entirely on the prenatal/postpartum mix: all 8 visits postpartum = (8 x $78.48) + $800 = $1,427.84 (the CEILING); all 8 visits prenatal = (8 x $66.48) + $800 = $1,331.84 (the FLOOR). Both endpoints are printed verbatim in the MDH manual, and my arithmetic reproduces both exactly. Reported figure 1428 is the state's own stated maximum. Additional structure: if a pregnancy does not result in a live birth, unused prenatal/postpartum visits may be redirected to postpartum and/or bereavement support, so the 8-visit ceiling holds regardless of outcome. Labor and delivery must be in person at a hospital or freestanding birth center with an OB-GYN, family medicine practitioner, or CNM present; it is not payable in the home. MDH requires MCOs to pay contracted doulas at least these minimum rates, so the figures are a floor for HealthChoice as well as the FFS rate.

NO RATE EXISTS TO DERIVE. Maine has no doula benefit in effect, therefore no covered codes, no unit limits, and no per-pregnancy cap. Exhaustive negative check: (1) the full MaineCare Benefits Manual index at 10-144 Chapter 101 was enumerated section by section, Chapter II (services) and Chapter III (allowances) both, and contains ZERO occurrences of the string 'doula' across 386 indexed documents; there is no doula section and no doula allowance section. (2) The MaineCare Recently Adopted Rules page (254KB) and Proposed Rules page (295KB) both contain zero occurrences of 'doula'. (3) The Maine Medicaid State Plan page (455KB) contains zero occurrences of 'doula'; no doula SPA is posted. (4) Maine's own Transforming Maternal Health (TMaH) Model page lists 'Element 3: Cover Doula Services Under MaineCare' under Pillar I as a FUTURE model element, i.e. the state describes covering doulas as something it intends to do, not something it does.

Source: MDHHS 'Doula Fee Schedule', January 2026 fee database (Doula-012026.xlsx, read directly from xl/sharedStrings.xml and xl/worksheets/sheet1.xml), cross-confirmed by MDHHS Medicaid Policy Bulletin MMP 24-40 issued 09/26/2024. Components: T1033 modifier HD, 'Sv Doula Brth Wrk Per Diem', attendance at labor and delivery, primary diagnosis Z33.1, rate $1,500.00, limit 1 per pregnancy = $1,500.00; S9445 modifier HD, 'Pt Education Noc Individ', prenatal and postpartum visits, primary diagnosis Z33.1 prenatal / Z39.2 postpartum, rate $100.00 per visit, limit 12 TOTAL visits per pregnancy across prenatal and postpartum combined, telemedicine eligible = 12 x 100 = $1,200.00. TOTAL PERINATAL BUNDLE = 1500 + 1200 = $2,700.00. Michigan publishes only these two codes for doulas, and both carry explicit per-pregnancy limits, so unlike Illinois the total here is a genuine, fully bounded, state-published maximum.

Minnesota sets doula rates IN STATUTE, not on the fee schedule. Minnesota Statutes 256B.758, Reimbursement for Doula Services, current text in the 2025 Minnesota Statutes: '(b) Effective for services provided on or after January 1, 2024, payments for doula services provided by a certified doula are $100 per prenatal or postpartum visit and $1,400 for attending and providing doula services at birth.' The per-pregnancy volume cap comes from the MHCP Provider Manual, Doula Services (revised September 16, 2025): 'MHCP covers up to 18 sessions without prior authorization. These 18 sessions can be completed anytime during the prenatal, labor and delivery, and postpartum period.' All sessions bill on a single code: T1033 with no modifier for non-labor-and-delivery sessions, T1033 with the U4 modifier for the labor and delivery session. A full bundle therefore uses 1 of the 18 sessions on the birth and the other 17 on prenatal/postpartum visits: 17 x $100.00 = $1,700.00, plus $1,400.00 for birth attendance = $3,100.00. If the doula does not attend the birth, all 18 sessions are visits and the maximum is 18 x $100 = $1,800.00.

6 support sessions x $75 (S9445 TH/TS) + 1 birth attendance (T1033 per diem) x $800 + 2 lactation (S9443) x $50 = $1,350. Limits from 13 CSR 70-25.160; rates from Practitioner.xlsx and Doula.xlsx.

No rate exists. NC Medicaid has no doula benefit, no doula clinical coverage policy, and no doula line on any fee schedule, so there is nothing to derive.

No rate exists. The ND Medicaid Professional Services Fee Schedule (data updated July 1, 2026) DOES list both doula HCPCS codes, and affirmatively marks them non-covered: T1032 'Sv doula brth wrk per 15 min' and T1033 'Sv doula brth wrk per diem' each carry Covered='No' with Professional Rate, Technical Rate, and General Rate all 0. This is an explicit exclusion, not an absence.

No rate exists yet and none can be derived, because the enacting statute expressly defers rate-setting. LB958 Sec. 4(2) says reimbursement 'shall be paid by state funds at rates determined by the department,' and Sec. 4(3)(a) requires the department to convene a stakeholder work group to develop an implementation plan 'including appropriate reimbursement rates,' due to the department no later than 2027-01-01. So the rates literally do not exist until at least 2027. There is also no per-pregnancy visit cap in statute; the bundle will be defined by the implementation plan, not by the legislature. Funding intent is identified but not appropriated as a rate: Sec. 4(5) states 'It is the intent of the Legislature to fund the state portion of reimbursement for doula services from the vital statistics subfund of the Health and Human Services Cash Fund.' NEGATIVE CONTROL ON CURRENT PAYMENT: Nebraska's SFY2026 outpatient and professional rates submission (SPA NE 25-0013, dated 2025-09-22) contains zero occurrences of 'doula' while the provider-type control hits, 'NURSE MIDWIFE SERVICES' appears as its own payment section (5 occurrences of midwife), confirming the document enumerates provider types and that doula is absent from it.

No dollar figure is publicly derivable yet, and the reason is timing, not absence of a cap. New Hampshire DOES cap per pregnancy: approved SPA 25-0015 Attachment 3.1-A item 13c sets a service limit of 'up to 8 visits per pregnancy which may include a combination of prenatal or postpartum visits,' exceedable only with prior authorization for medical necessity, and the Attachment 4.19-B payment page adds that 'Doulas services may only be billed once per pregnancy' and that 'Multiple births (i.e. twins, triplets) are not eligible for additional reimbursement.' So the bundle is 8 visits, once per pregnancy, no multiple-birth uplift. The SPA states the agency's fee schedule rate 'was set as of October 1, 2025' and directs readers to www.nhmmis.nh.gov. However, the CURRENT live NH fee schedule, '2026 Fee Schedule - Covered Procedures Report with SA Requirements as of 07-01-2026' (75,390 lines), contains NO doula line at all. POSITIVE CONTROL RUN AND PASSED: the same file was searched for codes known to be payable and they are present, 99213 Office/outpatient visit est at $46.77 (10 occurrences), 59400 obstetric global, 99401, and T1013, confirming the extraction and search work. The doula terms T1032, T1033, Z1034, and the literal string 'doula' return zero hits. This is expected rather than contradictory: that fee schedule is dated 07-01-2026 and CMS did not approve the SPA until 07-08-2026, a week later. The only public dollar figures attached to the benefit are aggregate fiscal notes, not rates: the CMS-179 shows a federal-share impact of $34,000 in FFY2026 and $68,000 in FFY2027, and the state's public notices project $136,000 total in each of FFY2026 and FFY2027 split $68,000 federal / $68,000 state. Those are program totals and must NOT be divided into a per-birth rate.

NJ caps doula services at a defined visit bundle per doula-member pair, so a per-pregnancy maximum IS computable. Structure from Newsletter Vol. 31 No. 04 (eff. 1/1/2021): 'Standard care (8 perinatal visits - 1 labor support visit, i.e. 8-1)' = up to 8 prenatal/postpartum visits including the option of 1 longer initial prenatal visit, plus attendance at the delivery. Unit rates read off the CURRENT FFS Procedure Master Listing (rates effective January 1, 2026): 99600 HD U7 INITIAL DOULA PRENATAL VISIT $16.62 per 15-min unit, max 6 units = $99.72, 1 per pregnancy; 99600 HD DOULA PRENATAL VISIT and 99199 HD DOULA POST PARTUM VISIT $16.62 per 15-min unit, max 4 units = $66.48 per visit, remaining 7 visits = 7 x $66.48 = $465.36; 59409 HD DOULA L&D NON C-SECTION $500.00 flat (or 59514 HD DOULA L&D C-SECTION $500.00 flat), 1 per pregnancy, no extra payment for non-singleton births; 99199 HD U8 DOULA INCENTIVE PAYMENT $100.00 flat, 1 per pregnancy, paid when the doula delivers a postpartum visit within 6 weeks and an obstetric clinician follow-up occurs. Core bundle = 99.72 + 465.36 + 500.00 = $1,065.08. With the conditional incentive = $1,165.08, recorded as 1165. Separate ENHANCED bundle for members age 19 or younger ('12-1'): 99.72 + 11 x 66.48 (=731.28) + 500.00 + 100.00 = $1,431.00. Managed-care rates may differ from these FFS maxima.

NULL BECAUSE NEW MEXICO PUBLISHES NO PER-PREGNANCY CAP. This is a genuine structural finding, not a gap in research, and it puts NM alongside Arizona and Illinois in the study's uncapped group. NM's limits are expressed PER CALENDAR YEAR, not per pregnancy or per birth, so no per-birth total exists to compute. The published structure (Supplement 25-01 Attachment A Table 1, and the identical Table 1 in MCO Letter of Direction #47) is: (1) T1032 + U1 modifier, prenatal and postpartum support, 1 unit = 15 minutes, limited to 2 hours (8 units) per day and to nine 2-hour visits per CALENDAR YEAR, with additional visits allowed on documentation of medical necessity; (2) T1033 + U3 modifier, non-medical labor and delivery support, billed per diem, maximum 1 unit; (3) T1032 + U2 modifier, counseling for pre-conception, pregnancy loss, infant loss, or termination of pregnancy, same 15-minute unit, same 2-hour daily and nine-visit annual limits, also exceedable on medical necessity. Because the nine-visit ceiling resets on the calendar year rather than the pregnancy, a pregnancy spanning a year boundary draws on two separate allotments, and because both T1032 limits are explicitly exceedable with documented medical necessity, even the annual ceiling is soft. No prior authorization is required within the limits. SEPARATELY, the per-unit dollar values are not retrievable: both Supplement 25-01 and LOD #47 print 'See Fee Schedule' in the Rate column and point to the HCA fee-for-service page, whose file list is rendered client-side by JavaScript and returns no document links to a non-browser client. Queries against the site's WordPress media library surfaced the doula policy documents but no practitioner or HCPCS fee schedule file containing T1032/T1033. CONFLATION AVOIDED: the approved SPA does contain a '$2,000 annual benefit limit,' but that figure belongs to item 5, CHIROPRACTIC services, not to item 6, doula services. It must not be reported as a doula cap.

Nevada enrolls doulas as Provider Type 90 and publishes a standalone PT 90 reimbursement schedule. Per-pregnancy limits come from Medicaid Services Manual Chapter 600, section 603.4E.2.c 'Service Limitations': 'Doula services for the same recipient and pregnancy are limited to the following: 1. Four visits during the prenatal/antepartum and/or postpartum period (up to 90 days postpartum). 2. One visit at the time of labor and delivery.' Rates from the PT 90 schedule (rate data as of 07/2026, every doula line carrying Rate Begin Date 10/01/2023): S9445 U1 'PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION' = $100.00 per session, 4 sessions allowed = $400.00; labor and delivery attendance = $900.00 flat, billed on whichever delivery code applies, all four priced identically: 59409 U1 VAGINAL DELIVERY $900.00, 59514 U1 CESAREAN DELIVERY $900.00, 59612 U1 VBAC $900.00, 59620 U1 CESAREAN AFTER VBAC ATTEMPT $900.00. Total = (4 x $100.00) + $900.00 = $1,300.00. The schedule's fifth line, T1015 'CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE' $439.86 under specialty 000, is a clinic encounter rate for doula services delivered inside an RHC/FQHC-type outpatient encounter, not something an individual doula adds on top of the bundle, so it is excluded.

NYC tier: T1032 perinatal visit $93.75 x 8 = $750.00, plus T1033 labor and delivery per diem $750.00 x 1 = $1,500.00. Rest-of-state tier totals $1,349.96. Read from the live eMedNY Doula_Fee_Schedule.xlsx (xl/sharedStrings.xml) and the eMedNY Doula Services Provider Policy Manual s13.6.

$1,230.00 total, derived by applying the service limits in OAC 5160-8-43(C)(2) to the maximum payment amounts in Appendix DD to rule 5160-1-60 (the non-institutional fee schedule). Each code was read from the Appendix DD spreadsheet cell by cell. (1) T1032, 'Sv doula brth wrk per 15 min', antepartum and postpartum support including consultation and telehealth visits, billed in 15-minute units, limited by rule to a MAXIMUM OF 48 UNITS per coverage period, current maximum payment amount $12.50 per unit, code effective date 2024-10-03: 48 x $12.50 = $600.00. (2) T1033, 'Sv doula brth wrk per diem', ONE comprehensive support service during labor and delivery regardless of duration, current maximum payment amount $600.00, code effective date 2024-10-03: 1 x $600.00 = $600.00. (3) T1023, 'Report of pregnancy (ROP)', ONE per coverage period, completed at first identification of pregnancy on form ODM 10257, listed in 5160-8-43(C)(2)(c) as a payable doula service, current maximum payment amount $30.00, code effective date 2021-07-01: 1 x $30.00 = $30.00. TOTAL = 600 + 600 + 30 = $1,230.00. This is a SOFT cap: 5160-8-43(C)(3) allows payment above these limits through the prior authorization process in rule 5160-1-31, so an individual pregnancy can exceed $1,230. Payment is the lesser of the provider's submitted charge or the Appendix DD maximum, except at an FQHC or RHC where Chapter 5160-28 encounter-rate rules govern instead, so FQHC/RHC-delivered doula care does not follow this arithmetic. POSITIVE CONTROL: the same parse of the same file returns 99213 at $46.23 non-facility / $33.74 facility, effective 2024-01-01, confirming the extraction reads codes, effective dates, and payment columns correctly.

NO PUBLISHED PER-PREGNANCY DOLLAR CAP. OHCA covers doula services under CPT codes appended with modifier HD: prenatal visits 59899/HD, postpartum visits 59899/HD (combined limit 8 prenatal+postpartum visits), and one labor & delivery visit billed 59409/HD (vaginal), 59514/HD (cesarean), 59612/HD (VBAC) or 59620/HD (cesarean after VBAC attempt). The published SoonerCare Title XIX Provider Fee Schedule effective 07/01/2026 contains ZERO rows carrying an HD modifier (verified: awk on modifier column returned 0 HD rows across the whole file). The base 59899 row is priced 'MANUAL' at $0.00, i.e. manually priced by OHCA per claim, so no dollar amount is published for the doula prenatal/postpartum visit at all. The base rows for 59409 ($641.33), 59514 ($729.90), 59612 ($729.15), 59620 ($754.89) are RBRVS PHYSICIAN delivery rates for actually performing the delivery and must NOT be reported as doula reimbursement; a doula bills the same code with the HD modifier at a separate, unpublished rate. POSITIVE CONTROL: the same file returns 99213 = $83.63 (RBRVS, eff 07/01/2026), so the search method is sound and the absence of HD rows is a real finding, not a parsing failure. Total per birth is therefore not derivable from public OHCA documents; the only published cap is a VISIT cap (8 prenatal/postpartum + 1 labor & delivery).

Source: Oregon Health Authority, Health Systems Division, 'Birth Doula Fee-for-Service (Open Card) Billing Guide', January 2025, downloaded live from https://www.oregon.gov/oha/HSD/OHP/Tools/doula-billing-guide.pdf. Oregon bundles the perinatal benefit into a single global code rather than itemizing it. GLOBAL BUNDLE: T1033 modifier HD, 'Global doula benefit with support at delivery', $1,505.00, bill only once per pregnancy, billed after the day of delivery. The guide defines this global benefit as four maternity support visits (two before delivery and two after delivery) PLUS doula support provided on the day of delivery, so it is a complete prenatal + birth attendance + postpartum bundle. TOTAL = $1,505.00. Oregon also publishes the unbundled component rates used when a doula provides only part of the package: T1033 modifier 22, 'Doula services day of delivery only', $645.00; T1033 no modifier, 'Support visit', $215.00 each, up to 2 prenatal and 2 postpartum. Those components reconcile exactly to the global rate: (4 x 215) + 645 = 860 + 645 = $1,505.00, which independently confirms the global figure is arithmetically consistent and not a typo. SEPARATE ADD-ON, NOT PART OF THE BIRTH BUNDLE: OHA will pay up to four ADDITIONAL support visits at $215.00 each, billed separately beyond the global package, occurring in any combination of prenatal and postpartum and continuing for 12 months following the end of the pregnancy. Including that add-on, the absolute maximum a doula can bill per pregnancy is 1505 + (4 x 215) = $2,365.00.

NO PER-PREGNANCY CAP AND NO STATE-SET RATE OF ANY KIND, BY EXPLICIT DEPARTMENT POLICY. This is not a gap in publication, it is a deliberate design choice, stated verbatim in DHS's own Doula Provider Enrollment FAQ: 'Medicaid managed care organizations (MCOs) are to negotiate rates with certified doulas. The Department of Human Services will not set a rate that Medicaid MCOs need to pay. You will need to negotiate your rate directly with the Medicaid MCO.' There is consequently no doula fee schedule, no doula procedure code list, and no bundle to sum. Medical Assistance Bulletin 13-24-01 further confirms there is nothing to find on the fee-for-service side: 'Doulas are not currently identified as a distinct provider in Pennsylvania's Medicaid State Plan and therefore enrollment in the MA Program does not authorize them to bill for services under the Fee-for-Service delivery system.' Reimbursement is therefore a private contract term between each doula and each of PA's HealthChoices MCOs, and varies by plan and by doula. Any single dollar figure attributed to Pennsylvania is fabricated.

CAPPED, and the cap is enforced in the claims system rather than merely stated. From RI EOHHS 'Provider Enrollment and Billing for Doula Services' (slide 43, Billing Details): S9445 patient education, non-physician provider, PRENATAL services per 60 minutes, rate $100 per session, maximum 3 per pregnancy = $300; 59510 routine obstetric care (used as the labor and delivery doula service), rate $900, maximum 1 per pregnancy = $900; S9446 patient education, non-physician provider, POSTNATAL services per 60 minutes, rate $100, maximum 3 per pregnancy = $300. TOTAL = $1,500. The cap is independently confirmed by the claim edit: 'Claims will suspend if more than 7 services are billed and paid' (suspense edit 103, number of paid claims per recipient), denying with EOB 547 'Provider has exceeded the number of claims authorized.' 3 prenatal + 1 delivery + 3 postpartum is exactly 7 services, so the system ceiling and the rate arithmetic agree. Code 59400 (vaginal delivery variant) is listed alongside 59510 as a labor and delivery doula code but the slide states the $900 rate only against 59510 and does not restate it for 59400; the bundle total is unaffected since only one delivery code is payable per pregnancy.

No rate exists because no doula benefit exists. SCDHHS publishes 33 separate fee schedules and NONE is a doula fee schedule. The Base Physician Fee Schedule (FEE_P1454.xlsx, 19,582 rate rows) was parsed cell by cell: zero rows contain the string 'doula' in any casing, and neither T1032 nor T1033 (the HCPCS codes other states use for doula services) appears anywhere in the file. POSITIVE CONTROL: the same parse returns 99213 at $69.94 across multiple locality/modifier rows, proving the extraction reads real codes and rates correctly, so the doula absence is a true negative rather than a parsing artifact.

SOUTH DAKOTA PUBLISHES AN EXPLICIT PER-PREGNANCY DOLLAR CAP, stated verbatim in its Doula Services billing and policy manual under General Service Limits: 'Medicaid covers a maximum of $1,800 of doula services per pregnancy. This limit may be exceeded if additional hours are prior authorized by Medicaid using the General Prior Authorization Form.' The $1,800 is therefore the full perinatal bundle ceiling, spanning prenatal, labor and delivery, postpartum, and care coordination combined, and is a SOFT cap: it can be exceeded with prior authorization, so an individual pregnancy can exceed $1,800. Two codes fill that ceiling: T1032 (prenatal, postpartum, or care coordination services), a TIME-BASED code billed in 15-minute units under an 8-minute midpoint rule, cumulative across a single date of service; and T1033 (labor and delivery services), limited to one visit per recipient per pregnancy. Payment is the lesser of the provider's usual and customary charge or the fee on South Dakota Medicaid's doula fee schedule. The per-unit dollar amounts for T1032 and T1033 are published on a separate 'Doula Services' fee schedule that DSS hosts as an embedded Power BI report (app.powerbigov.us) rather than as a PDF or spreadsheet; the underlying data could not be machine-read, so the per-unit rates are unconfirmed here. This does not affect the reported figure: $1,800 is the state's own stated per-pregnancy total and is the more meaningful number regardless of how the units are priced.

NO RATE EXISTS TO DERIVE. Tennessee publishes no doula fee schedule, no doula procedure codes, no doula billing manual, and no per-pregnancy cap, because TennCare has no doula benefit. What exists instead is (1) a statutory advisory committee and (2) five MCO-run pilot programs. The Doula Services Advisory Committee's March 2025 report to the Legislature, section 'Recommended Reimbursement Rates and Fee Schedules', states outright: 'The Committee did not achieve consensus in determining a recommended reimbursement rate and fee schedule for doula services. There were various rates and strategies proposed by committee members.' The only concrete schedule in the report is one member's PROPOSAL totalling up to $1,715 (initial visit $100; prenatal $75 x up to 3; delivery $900 vaginal or cesarean; postpartum $85 x up to 4; plus two $60 incentive payments). It is a proposal, not policy. The one real Tennessee dollar figure is pilot compensation, not a Medicaid rate: the Nashville Strong Babies pilot paid participating doulas 'an hourly differentiated rate for prenatal support, a flat rate for labor and delivery support, and an hourly differentiated rate for postpartum and lactation support', with 'total compensation was $900', plus mileage and childcare reimbursement.

No rate exists. The BMS policy manual index runs Chapters 100 through 900 (including 519 Practitioner Services, 522 FQHC, 533 Birthing Centers) with no doula chapter and no doula service category, so there is no payable code to price.

No rate exists. Downloaded the live Wyoming Medicaid master fee schedule (FeeSchedule.xlsx, 5.0 MB, 189,390 unique strings, modified 2026-07-07) past the CPT license gate and searched it directly: 'doula' 0 hits, 'T1032' 0 hits, 'T1033' 0 hits. Any dollar figure attributed to Wyoming would be fabricated.