Medicaid Doula Requirements in New York

As of Jan 22, 2026

New York has a statewide Medicaid doula benefit—and it’s a big opportunity for doulas who want to serve families while building a sustainable practice. But like every state, New York’s Medicaid rules are specific: eligibility windows, documentation, provider enrollment, billing codes, and where you submit claims all matter.

1) What New York Medicaid covers for doulas

NYS Medicaid covers doula services during pregnancy and up to 12 months after the pregnancy ends (regardless of pregnancy outcome).

Under the NYS Medicaid doula benefit, doulas can be reimbursed for:

• Up to 8 perinatal visits (prenatal and/or postpartum) per pregnancy
• 1 labor & delivery encounter per pregnancy

Important service rules

• Each perinatal visit must include at least 30 minutes of direct interaction to be reimbursable.
• Labor & delivery is generally in-person (telehealth only in limited extenuating circumstances under NY telehealth policy).
• You cannot balance bill Medicaid members—Medicaid payment is considered payment in full.

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2) The “medical requirement” that makes doula services billable in NY

In New York, doula services are treated as a preventive service, which means they must be recommended by a physician or other licensed practitioner of the healing arts to be eligible for Medicaid reimbursement.

Standing order (the big simplifier)

New York issued a statewide standing order for doula services effective June 10, 2024, which can be used in place of an individual practitioner recommendation.

What this means in practice: you still need to document that a recommendation requirement is satisfied—but the standing order can fulfill it, reducing friction for clients and doulas.

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3) How doulas enroll as NY Medicaid providers (FFS + Managed Care)

Step 1: Enroll in NY Medicaid Fee-for-Service (FFS)

To be reimbursed, you must be actively enrolled as a doula services provider in NYS Medicaid.

Core qualification requirements include:

• NPI
• Age 18+
• Adult & Infant CPR
• Doula-specific liability insurance
• Completion of the NYS Medicaid FFS Doula Directory form

Step 2: If you want to serve Managed Care (MMC) members

New York’s policy has included a “carve-out” period where services were billed to FFS even for managed care members; then it transitions into managed care plan billing.

• The current statewide policy manual explains that doulas billed FFS during the carve-out (March 1, 2024–March 31, 2025) and that for dates of service on/after April 1, 2025, services are added to MMC benefit packages(i.e., you bill the plan, with continuity-of-care rules).
• eMedNY’s enrollment guidance also notes: to become a doula provider for NY Medicaid Managed Care members, you first enroll as FFS, then apply to join MCO networks.

4) Billing codes New York doulas use (and what to put on the claim)

New York’s doula billing uses HCPCS codes tied to specific allowable ICD-10 diagnosis codes.

Covered doula billing codes (NYS Medicaid)

Perinatal visits (prenatal/postpartum):

• T1032 — “Services provided by a doula birth worker” (perinatal support; minimum 30 minutes)
• Allowed diagnosis codes include:
  • Z32.2 (prenatal/pregnancy) or
  • Z32.3 (postpartum)

Labor & delivery:

• T1033 — “Services provided by a doula birth worker, per diem” (in-person labor support; must be present for the birth)
• Allowed diagnosis code includes:
  • Z32.2

Visit limits (per pregnancy)

• T1032: up to 8 times
• T1033: up to 1 time

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5) Current NY Medicaid doula reimbursement rates (what you can expect)

Rates can change, and official fee schedules are maintained through eMedNY. The NYS policy manual notes the FFS fee schedule is effective March 1, 2024, and eMedNY provides the fee schedule materials for doulas.

A commonly cited snapshot (from the National Academy for State Health Policy tracker) lists New York rates as:

• Up to 8 perinatal visits: $84.37 per visit
• Labor & delivery encounter: $675

Because rates may be updated, treat those as a reference point and verify the latest FFS amounts via eMedNY fee schedule resources before you publish or price packages.

6) How to file claims and get reimbursed (FFS billing basics)

New York allows doulas to bill Medicaid either electronically or on paper:

• Electronic claims: use the HIPAA 837P transaction
• Paper claims: use the NYS Medicaid eMedNY-150003 claim form

If you’re newer to billing: most doulas choose one of these workflows:

1. Bill directly through a billing platform/clearinghouse that supports 837P, or
2. Work with a medical biller (especially helpful in the first 1–3 months), or
3. Submit paper claims while you ramp up (slower, but straightforward).

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✅ New York Medicaid Doula Checklist

Eligibility & benefit rules

• ☐ Client is covered by NY Medicaid and within pregnancy or up to 12 months postpartum
• ☐ Services planned fit within limits: 8 perinatal visits + 1 L&D
• ☐ Perinatal visits include ≥30 minutes direct interaction

Medical “recommendation” requirement

• ☐ Document recommendation requirement (standing order can be used on/after June 10, 2024)

Provider enrollment

• ☐ NPI obtained
• ☐ Adult & Infant CPR current
• ☐ Doula-specific liability insurance active
• ☐ NYS Medicaid doula enrollment completed (FFS first; then MCO contracting if needed)

Billing codes (use on claims)

• ☐ T1032 for perinatal visits + ICD-10 Z32.2 (pregnancy) or Z32.3 (postpartum)
• ☐ T1033 for labor & delivery + ICD-10 Z32.2

Submitting claims

• ☐ Submit via 837P (electronic) or eMedNY-150003 (paper)
• ☐ Do not charge the Medicaid client extra (no balance billing)

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‍Here is the official policy manual for download.

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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.