April 5, 2021
A doula is a person who provides emotional and physical support to a member’s pregnancy and childbirth. For Staywell members, this benefit is now available to all pregnant members, ages 13 and older, effective October 1, 2020.
Benefits of a doula include:
During pregnancy, doulas offer support by:
- Answering questions about the childbirth process
- Developing a birth plan
At delivery:
- Stays with the member constantly to provide comfort and support
- Helps communicate the member’s preferences to the medical staff
After delivery:
- Teaches the member how to care for the new baby
- Provides support and encouragement after the member brings the baby home
Below is a list of codes, description, and benefit limitations. Some services may require prior authorization. The billing codes are applicable to Staywell and Children’s Medical Services (CMS) Health Plan members.
|
Procedure codes performed by the doula |
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|
Code |
Modifier |
Service Description |
Benefit Limitation |
|
S9442 |
|
Birthing classes, non-physician provider, per session |
Unlimited |
|
S9443 |
|
Lactation classes, non-physician provider, per session |
Unlimited |
|
S9444 |
|
Parenting classes, non-physician provider, per session |
Unlimited |
|
S9445 |
|
Prenatal education (patient education non classified, non-physician) |
Unlimited |
|
S9445 |
TS |
Postpartum education (patient education non classified, non-physician) |
Unlimited |
|
S9446 |
|
Prenatal patient education, not otherwise classified, non-physician provider, group, per session |
Unlimited |
|
S9446 |
TS |
Postpartum patient education, not otherwise classified, non-physician provider, group, per session |
Unlimited |
Below of is a list of codes, description, and benefit limitations. Some services may require prior authorization.
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Procedure codes not performed by the doula, but the doula may indicate their presence during the procedure through the use of the XU modifier |
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|
Code |
Modifier |
Service Description |
Benefit Limitation |
|
59400 |
XU |
Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care |
1 per delivery |
|
59409 |
XU |
Doula support for vaginal delivery only |
1 per delivery |
|
59510 |
XU |
Standard doula benefit with support at cesarean delivery; Global code: routine obstetric care including antepartum care, C-section delivery, and postpartum |
1 per delivery |
|
59514 |
XU |
Doula support for Cesarean delivery only |
1 per delivery |
|
59610 |
XU |
Standard doula benefit with support at VBAC delivery; Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery |
1 per delivery |
|
59612 |
XU |
Doula support for VBAC delivery only, with or without episiotomy and/or forceps |
1 per delivery |
|
59618 |
XU |
Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery |
1 per delivery |
|
59620 |
XU |
Doula support for Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery |
1 per delivery |
For more information, please contact your provider relations representative or call:
1-866-334-7927 – Staywell Health Plan
1-866-799-5321 – Children’s Medical Services Health Plan
