Medicaid Doula Requirements in Illinois

As of Jan 23, 2026

llinois Medicaid (the Medical Assistance Program) now covers doula services statewide—through both fee-for-service (FFS) and HealthChoice Illinois managed care organizations (MCOs).

That means doulas can build a more sustainable practice while expanding access for families—but only if you understand Illinois’ specific pathway: get certified, enroll as a Medicaid provider, document the preventive-services “recommendation” requirement, bill the right codes with the right modifiers/fields, and submit claims correctly.

1) The “medical requirement” Illinois must meet: preventive-services recommendation

Doula services are covered as a preventive service, which triggers a federal requirement: the service must be recommended by a licensed provider.

Illinois meets this requirement through a statewide Standing Recommendation for Doula Services, issued by the Illinois Department of Public Health (IDPH). It states that all Medicaid recipients who are pregnant or up to 12 months postpartum (regardless of pregnancy outcome) would benefit from doula services.

What doulas must do: In your documentation, you must note whether you used (1) the standing recommendation or (2) a recommendation from a specific licensed physician, PA, or APRN—for audit purposes. This note goes in your records, not on the claim.

2) Illinois certification: required before Medicaid enrollment

Before you can enroll and bill Illinois Medicaid as a doula, you must obtain a certificate from the Illinois Medicaid-Certified Doula Program, administered by Southern Illinois University (SIU) School of Medicine.

Key details:

• SIU issues a certificate with a unique certification number and effective/expiration dates. Newmom.me Academy's Doula training is approved by state of Illinois.
• Certification is valid for three years, after which doulas must recertify and submit proof to HFS.

3) How doulas enroll as Illinois Medicaid providers (IMPACT)

Illinois Medicaid provider enrollment happens through the IMPACT system, and reimbursement is available to certified doulas enrolled in IMPACT.

Enrollment options in IMPACT (choose what matches your work model)

Illinois identifies two practical enrollment types for doulas:

1. Rendering/Servicing Provider
   You provide services but do not submit claims directly—you must associate with a billing organization (group practice/agency/FAO).
2. Regular Individual/Sole Proprietor
   You can receive payments directly (and can still associate with billing providers/agents if you want).

You must have an NPI to enroll.

Taxonomy code (Illinois doula billing identity)

Illinois lists the taxonomy code for doula services as: 374J00000X.

4) Illinois doula billing codes (what you can bill Medicaid for)

Illinois publishes the billable procedure codes for doulas in its provider notice, and the fee schedule confirms rates and unit rules.

Core doula billable codes in Illinois (HFS)

• S9445 – Non-physician prenatal patient education (billed in 15-minute increments)
• S9444 – Postpartum parenting education/advocacy/resource connection (billed in 15-minute increments)
• 59409 – Labor support (vaginal delivery only)
• 59514 – Labor support (cesarean delivery)
• 59612 – Labor support (VBAC vaginal delivery)
• 59620 – Labor support (cesarean following attempted VBAC)
• 59430 – Postpartum visit attendance with practitioner/OB (special timing rules—see below)
• 99381 – Initial newborn visit facilitation & attendance (must occur within 2 weeks; billed under the newborn’s RIN; can be billed per child for multiples)
• T1032 – Doula support during/after miscarriage or abortion (billed in 15-minute increments)

Important limit rules

• Labor support codes are limited to 1 unit per pregnancy.
• 59430 postpartum attendance is payable up to 2 units per delivery and only within specific postpartum time windows (below).

5) Current Illinois Medicaid FFS doula rates (HFS fee schedule)

Illinois posts a dedicated Doula Fee Schedule and an updated PDF (effective 02/01/2024, updated 09/22/2025).

Here are the key rates from the current fee schedule:

Education & support (billed in 15-minute units)

• S9445 prenatal education: $15 per 15 min
• S9445 HQ group prenatal education: $5 per 15 min
• S9444 postpartum education/resource support: $15 per 15 min
• S9444 HQ group postpartum education: $5 per 15 min
• T1032 miscarriage/abortion support: $15 per 15 min

Labor & delivery (per pregnancy)

• 59409 / 59514 / 59612 / 59620 labor support: $720 (1 unit per pregnancy)

Attendance-based supports

• 59430 postpartum visit attendance: $50 (max 2 units per delivery; timing rules apply)
• 99381 initial newborn visit facilitation/attendance: $50 (1 unit per child; must occur within 2 weeks)

6) Illinois “gotchas” that cause denials (and how to avoid them)

A) Postpartum visit attendance (59430) has strict timing rules

Illinois will reimburse 59430 only when the doula attends the postpartum practitioner/OB visit and the visit occurs:

• within 26 days from delivery, and/or
• between 27–89 days from delivery.

Illinois also states there is a maximum of 2 postpartum attendance payments (one per time period).

B) Delivery date must be reported on the claim (for postpartum attendance)

To get paid for 59430, the actual delivery date must be reported on the claim (Illinois specifies where in the 837P it must appear).

7) Telehealth rules (Illinois)

Illinois allows telehealth for:

• S9444, S9445, and T1032
  …using modifier GT (audio/video) or 93 (audio-only), and place of service 02 or 10 as applicable.

(Labor support codes are not listed as telehealth-allowable in the doula notice.)

8) How to file for reimbursement in Illinois (FFS + managed care)

Illinois covers doula services under both FFS and MCOs.

Step-by-step: the cleanest reimbursement workflow

Step 1: Confirm you’re eligible to bill

• You have your SIU certificate (not expired), and it’s uploaded for enrollment.
• You are enrolled in IMPACT (as Sole Proprietor or Rendering Provider with a billing entity).

Step 2: Document the “recommendation” requirement

• In your service note, record whether you used the IDPH standing recommendation or an individual licensed provider recommendation.

Step 3: Deliver and document the service

• Track visit duration for 15-minute unit codes.
• For 59430 postpartum attendance, confirm the visit falls within the allowed postpartum windows.

Step 4: Submit the claim correctly
Illinois states doula claims are billed electronically on the 837 Professional (837P) transaction. Claims may also be submitted via direct data entry in the MEDI system.

Step 5: Include special claim fields when required

• For postpartum attendance (59430), include the delivery date in the claim where Illinois instructs (to trigger payment).

Step 6: If the member is in managed care
Follow the MCO’s claim submission process (coding/rules still apply), since doulas are also covered under HealthChoice Illinois MCOs

Illinois Medicaid Doula Checklist

• ☐ Get certified through SIU Medicaid-Certified Doula Program (valid 3 years)
• ☐ Enroll in IMPACT (choose Sole Proprietor vs Rendering Provider)
• ☐ Use taxonomy 374J00000X
• ☐ Document standing recommendation (or licensed provider recommendation) in your notes
• ☐ Bill using Illinois doula codes (S9445, S9444, labor codes, 59430, 99381, T1032)
• ☐ Follow fee schedule rates and unit rules (15-min increments where applicable)
• ☐ Submit claims via 837P or MEDI direct data entry
• ☐ For 59430, ensure the visit timing qualifies and include the delivery date on the claim

Here is the link to their official website for the latest information.

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Disclaimer: This blog's content is provided for informational purposes only, and does not intend to substitute professional medical advice, diagnosis, or treatment and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any personal, professional, legal, medical and financial or tax-related decisions.