Medicaid Doula Requirements in Washington State

As of Jan 23, 2026

Washington State’s Medicaid program is called Apple Health. As of January 1, 2025, Washington launched a statewide birth doula benefit—and it’s one of the most financially meaningful doula benefits in the U.S. (with a per-pregnancy cap built into the design).

But like every Medicaid program, success comes down to the basics: meet provider requirements, enroll correctly, bill with the right codes/units/diagnosis codes, and submit claims through the correct system.

1) What Apple Health covers for birth doulas in Washington

Washington’s Apple Health birth doula benefit covers:

• One prenatal intake visit
• Continuous labor & delivery support
• 20 hours for additional prenatal + postpartum support (including one comprehensive postpartum visit)

The HCA billing guide also specifies the benefit must be preventive in nature (under federal preventive-services rules).

The “20 hours” structure (important for billing)

The billing guide explains a maximum of 20 hours (80 units) is available across prenatal and postpartum visits, with 6 units (90 minutes) designated specifically to support postpartum care (including the comprehensive postpartum visit).

2) The “medical requirements” to participate (what you need as a doula)

Even though doulas are non-clinical, Apple Health requires specific provider readiness steps.

To be reimbursed by HCA, doulas must:

• Have a current voluntary Washington Department of Health (DOH) birth doula credential. Newmom.me Academy's Birth Doula training is one of the approved organizations.
• Have an NPI
• Enroll with HCA/ProviderOne as a billing provider
• Follow the HCA billing guide requirements

HCA’s provider enrollment guidance also lists required enrollment documents (e.g., Core Provider Agreement, Debarment Statement, W-9) and calls out business license + professional liability insurance for both individual and organization (FAOI) billing providers.

And DOH hosts the official birth doula credential process and reference information.

3) How doulas enroll (Washington): DOH credential → NPI → ProviderOne

HCA summarizes the enrollment pathway clearly:

1. Complete DOH voluntary birth doula certification
2. Obtain your NPI
3. Enroll with ProviderOne (Washington’s Medicaid billing/eligibility system)

4) Washington billing codes doulas use (and how billing actually works)

Washington’s birth doula billing guide provides the core billing table and rules.

A) Prenatal intake visit (flat rate)

• CPT 59899 + modifier U1
• Diagnosis code: Z32.2
• Must be in person, minimum 2 hours of direct service time
• Billed once per pregnancy (single date of service)

B) Labor & delivery support (flat rate)

• HCPCS T1033
• Diagnosis code: Z37.9
• Must be in person, continuous, one client at a time
• Billed once per pregnancy (flat rate applies regardless of length of labor)

C) Additional prenatal and postpartum visits (paid in 15-minute units)

• HCPCS T1032
• Prenatal diagnosis: Z32.2
• Postpartum diagnosis: Z39.2
• 1 unit = 15 minutes
• Combined maximum: 20 hours (80 units) across prenatal + postpartum
• Billing guide emphasizes these visits must not be billed as part of labor support (T1033) and should be billed as a single date of service

5) Current Apple Health (Washington) fee-for-service rates (FFS)

Washington pays birth doula services through its fee-for-service system, using HCA’s published birth doula fee schedule.

The HCA fee schedule (effective January 1, 2025) lists these maximum allowable fees:

• 59899 + U1 (Prenatal intake): $750
• T1033 (Labor & delivery support): $750
• T1032 (Prenatal/Postpartum visits): $25 per 15-minute unit

What this means in plain numbers

• T1032 at $25/unit = $100/hour
• 80 units (20 hours) × $25 = $2,000
• $2,000 (T1032) + $750 (intake) + $750 (labor) = $3,500 max per pregnancy, consistent with HCA communications about the benefit design.

(Rates can be updated—always confirm the latest fee schedule.)

6) Managed care members: where do you bill?

A critical Washington-specific detail:

Even if the client is enrolled in an HCA-contracted managed care plan, HCA pays birth doula services through the fee-for-service system—and doulas bill HCA directly.

So your operational default is: verify eligibility in ProviderOne → bill HCA FFS, even for managed care clients.

7) How to file for reimbursement (Washington): the practical workflow

Washington keeps this straightforward compared to many states: you file claims through ProviderOne.

Step-by-step reimbursement workflow (plain English)

Step 1 — Verify client eligibility + enrollment type

• Use ProviderOne to confirm the client is eligible for Apple Health and (if in managed care) check managed care enrollment in ProviderOne.

Step 2 — Deliver the service according to billing-guide rules

• Intake visit must be in-person, 2 hours minimum.
• Labor support must be in-person and continuous.
• T1032 visits must be billed in 15-minute units and must not be bundled into labor support.

Step 3 — Document clearly
The billing guide includes documentation expectations (e.g., date/time/duration, consent, components of intake). If your charting doesn’t match the guide, claims can become harder to defend.

Step 4 — Submit your claim in ProviderOne
HCA’s billing hub is explicit: after you complete a service, file claims through the ProviderOne portal, using billing guides + the ProviderOne Billing & Resource Guide to complete the process.

Step 5 — Track units so you don’t exceed the 20-hour limit
HCA recommends doulas track units billed, because the claim that pushes beyond the limit is only payable up to the remaining allowable units.

8) Washington “Medicaid-ready” checklist

✅ Washington Apple Health Birth Doula Checklist

Provider requirements

• ☐ Active WA DOH birth doula credential
• ☐ NPI obtained
• ☐ Enrolled in ProviderOne as a billing provider
• ☐ Business license + professional liability insurance (per enrollment guidance)

Covered services + limits

• ☐ 1 prenatal intake (in-person, 2 hours)
• ☐ 1 continuous labor & delivery support (in-person)
• ☐ Up to 20 hours (80 units) of prenatal/postpartum support via T1032

Codes + rates (FFS)

• ☐ 59899 + U1 = $750 (intake)
• ☐ T1033 = $750 (labor)
• ☐ T1032 = $25 per 15-min unit

Billing + submission

• ☐ Verify eligibility in ProviderOne
• ☐ Submit claims through ProviderOne (bill HCA directly—even for managed care clients)
• ☐ Track units to stay within the 80-unit limit

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.