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CO HCPF Doula Billing Manual — Billing Information

BillingInformation

activein force · 2026-07-26 – presentas-observed

RefertotheGeneralProviderInformationManuallocatedontheBillingManualswebpageundertheGeneralProviderInformationdrop-downforgeneralbillinginformation.

ThetermThird-PartyLiability(TPL)describescircumstanceswhenaHealthFirstColoradomemberhashealthinsuranceorotherpotentialresources-inadditiontotheHealthFirstColoradoprogram-thatmaypayformedicalservices.

Anestimated10%ofHealthFirstColoradomembershaveotherhealthinsuranceresourcesavailabletopayformedicalexpenses.

WhilemostbenefitsrequireaprocessbywhichMedicaidwouldbethepayeroflastresortbecauseFederalregulationsrequirethatallavailablehealthinsurancebenefitsbeusedbeforeHealthFirstColoradoconsiderspayment,ThirdPartyLiability(TPL)editswillbeautomaticallybypassedforbothcommercialinsuranceandMedicarewhenclaimsaresubmittedbythefollowingprovidertypes:

PT70-LactationConsultant

PT72-Lactation/DoulaProfessionalGroup

PT79-Doula

FormoreinformationonTPL,pleasevisitthegeneralproviderbillingmanualsectionthatdiscussestheserulesingreaterdepth.

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Doulaservicesarebilledusingtwo(2)HealthcareCommonProcedureCodingSystem(HCPCS)procedurecodes,two(2)InternationalClassificationofDiseases(ICD)-10diagnosiscodes,andacombinationofmodifiercodesifservicesaredeliveredviatelemedicine.Themodifiercodesshownbelowshouldonlybeusedincircumstancesinvolvingtelemedicine.

Coveredservicesarelimitedto180minutesofprenatalcareand180minutesofpostpartumcarepermember,andoneinstanceoflaboranddeliverypermemberpregnancyduringa12-monthperiodregardlessofthenumberofdoulaproviderswhotreatthatmember.

Amemberordoulacannotdistributethatamountdifferently,andthoseservicesaremaxedouttothemember.Forexample,ifone(1)doulaisreimbursedforone(1)60-minutevisitandone(1)90-minutevisitduringtheprenatalperiod,aseconddoulacanonlybereimbursedfortheremaining30minutes(two(2)unitsofservice)forthatsamemember.

Shouldadoulaidentifyaneedbeyondtheseadditionalapprovedservicestheymayreachouttothemember’sRegionalAccountableEntityforcarecoordination.

PrenatalDoulaServices:Adoulacanbereimbursedforupto180minutesofprenatalcarepermemberforHCPCSProcedureCodeT1032.Thereisalimitof12unitsofservicepermemberduringa12-monthperiod(periodstartsatthetimeofthefirstdoulaclaim).

PostpartumDoulaServices:Adoulacanbereimbursedforupto180minutesofpostpartumcareforHCPCSProcedureCodeT1032.Thereisalimitof12unitsofservicepermemberduringa12-monthperiod(periodstartsatthetimeofthefirstdoulaclaim).

LaborandDelivery:Adoulamaybereimbursedforlaboranddeliverysupportservicesoncepermemberwithina12-monthperiod.ReimbursementisbilledunderHCPCSProcedureCodeT1033,regardlessofthelengthofthelaboranddelivery.Thedoulaandmembershoulddiscussexpectationsandprocessesshouldthelaboranddeliveryexceedthetimethatthedoulaisabletoassist.

PertheHCPFGeneralProviderBillingManualguidance,providersareadvisedtobilltheirusualandcustomarycharges.RefertothecurrentHealthFirstColoradoFeeScheduleforrates.

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ProcedureCode

Description(short)

RequiredICD-10DiagnosisCodes

Limitationsper12-monthperiod

T1032

Doulabirthworkerservices,billedper15minutes.Usedforprenatalandpostpartumservices.

Thisisa‘timed’code.1unitofservice=15minutesofdirectmembercontactservicesprovided.Instructionsforroundingincrementsarefoundbelow.

Telemedicineservicedeliveryisallowed.

Prenatal

Services:

Z33.1

PostpartumServices:

Z39.2

12unitsofservice(180minutes)coveredpermemberpregnancyforPrenatalservices,

and

12unitsofservice(180minutes)coveredpermemberpregnancyforPostpartumservices

T1033

Doulabirthworkerservices,perdelivery.Usedforlaboranddeliveryservices.

Thisisan‘untimed’code.1unitofservice=alldoulaservicesprovidedduringamember’slabor&delivery.Thiscodeisonlytobereportedoncepermember,perdelivery.

Telemedicineservicedeliveryisnotallowed.

Z33.1

1unitofservicecoveredpermemberpregnancy

ModifierCodesforTelemedicineServiceDeliveryforT1032Only

Description

Theservicewasfurnishedusingaudio-onlycommunicationtechnology.

Thesupervisingpractitionerwaspresentthroughtwo-way,audio/videocommunicationtechnology.

SynchronousTelemedicineServiceRenderedViaTelephoneorOtherReal-TimeInteractive-Audio-OnlyTelecommunicationsSystem

SynchronousTelemedicineServiceRenderedViaaReal-TimeInteractiveAudioandVideoTelecommunicationsSystem

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WhenreportingserviceunitsforCPT/HCPCScodeswheretheprocedureisnotdefinedbyaspecifictimeframe("untimed"CPT/HCPCS),theproviderenters"1"inthefieldlabeled"units."Foruntimedcodes,unitsarereportedbasedonthenumberoftimestheprocedureisperformed,asdescribedintheCPT/HCPCScodedefinition.

Example1:Amemberreceiveddoulabirthworkerservicesrelatedtoadelivery,representedbyHCPCS"untimed"codeT1033.Regardlessofthenumberofminutesspentprovidingthisservice,onlyone(1)unitofserviceisappropriatelybilled.

HCPCScodeT1032specifiesthatthedirect(one-on-one)timespentinpatientcontactis15minutes.Providersreportthese"timed"procedurecodesforservicesdeliveredonanysinglecalendardayusingHCPCScodesandtheappropriatenumberof15-minuteunitsofservice.

Example2:Amemberreceivedatotalof60minutesofprenataldoulabirthworkerservicescodesusingHCPCS"timed"codeT1032whichisdefinedin15-minuteunits,onagivendateofservice.Theproviderwouldthenreportfour(4)unitsofcodeT1032.

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Whenonlyone(1)serviceisprovidedinaday,providersshouldnotbillforservicesperformedforlessthaneight(8)minutes.ForanysingletimedHCPCScodeinthesamedaymeasuredin15-minuteunits,providersbillasingle15-minuteunitfortreatmentgreaterthanorequaltoeight(8)minutesthroughandincluding22minutes.Ifthedurationofasinglemodalityorprocedureinadayisgreaterthanorequalto23minutes,throughandincluding37minutes,thentwo(2)unitsshouldbebilled.Timeintervalsforone(1)througheight(8)unitsareasfollows:

BilledUnitsIncrement

TimeSpentinDirectPatientContact

1unitofservice

8minutesthrough22minutes

2unitsofservice

23minutesthrough37minutes

3unitsofservice

38minutesthrough52minutes

4unitsofservice

53minutesthrough67minutes

5unitsofservice

68minutesthrough82minutes

6unitsofservice

83minutesthrough97minutes

7unitsofservice

98minutesthrough112minutes

8unitsofservice

113minutesthrough127minutes

Thepatternremainsthesamefortreatmenttimesinexcessoftwo(2)hours.

Example3:Amemberreceivedatotalof105minutesofprenataldoulabirthworkerservicescodesusingHCPCS"timed"codeT1032whichisdefinedin15-minuteunits,onagivendateofservice.Theproviderwouldthenreportseven(7)unitsofcodeT1032.

Theprovidermustmaintaindocumentationinaccordancewith10CCR2505-108.130.2.thatcomplieswithstateandfederalregulations.Thedoulashouldbeabletoquicklyidentifyandshareinformationabouteachvisit,includingtimestampsforthedurationofeachvisitprovidingdirectservicetoaneligiblemember.Thisisusedtovalidatethenumberofunitsofservicebilledforreimbursement.

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DoulaservicesarenotincludedinHealthFirstColoradophysicalhealthmanagedcareplans,howeverdoulaservicesarestillcoveredbenefitsformembersenrolledinthoseplans.AllclaimsfordoulaservicesshouldbebilledtotheDepartment’sFiscalAgent,GainwellTechnologies,evenifthememberisattributedtoaHealthFirstColoradophysicalhealthmanagedcareplan.

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Doulascanprovideprenatalandpostpartumcareinvarietyofsettings,includingthemember’shome,clinicsandprovideroffices,community-basedsettingsorviatelehealth.Afulllistofallowableplacesofservicefordoulaservicesareindicatedbelow.

Laboranddeliveryservices(T1033)cannotbeprovidedviatelemedicinewithPlaceofServicecodes02or10.Whiledoulasmustprovidein-personlaboranddeliverysupport,locationcanvary.

OfficialdescriptorsofthePlaceofServicecanbefoundontheCMSwebsite.

AllowedPlaceofServiceCode

Description(short)

TelehealthProvidedOtherthaninPatient’sHome

School

HomelessShelter

IndianHealthServiceFree-standingfacility

IndianHealthServiceProviderbasedfacility

Tribal638Provider-basedFacility

Prison/CorrectionalFacility

TelehealthProvidedinPatient’sHome

Office

Home

OffCampus-OutpatientHospital

UrgentCareFacility

InpatientHospital

OnCampus-OutpatientHospital

EmergencyRoom

BirthingCenter

FederallyQualifiedHealthCenter

CommunityMentalHealthCenter

ResidentialSubstanceAbuseTreatmentFacility

Non-residentialSubstanceAbuseTreatmentFacility

PublicHealthClinic

RuralHealthClinic

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ContacttheProviderServicesCallCenterwithbillinginquiries.

ContacttheDepartment'sDoulaBenefitpolicyspecialistathcpf_maternalchildhealth@state.co.usforallotherinquiries.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: b5a4796889ee005aae97a9b527ec4fc7745b2e497b3fac9df8e2f77e95357d69

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