General Rate Provisions and Payment

(1) Individual Consideration and Nonlisted Procedures. Rates of payment for doula services that are authorized but not listed in 101 CMR 319.00, services performed in unusual circumstances, and services whose fees are designated by the letters “I.C.” are determined on an individual consideration basis. (2) Fee Schedule. Certain doula services are not associated with CPT codes that have a service- specific description, and therefore must be billed for by using a CPT code that represents unlisted services (Unlisted Service Code) in accordance with the fee schedule below. For such doula services, the doula service associated with each Unlisted Service Code is identified in the parenthetical description of the code description section of the fee schedule below. Code Rate Code Description Unlisted home visit service or procedure. (Perinatal visit up to 60 minutes.) 99600 TF Unlisted home visit service or procedure. (Perinatal visit from 61 minutes up to 90 minutes. This service must be identified by adding the modifier TF to the parent service code.) Unlisted special service, procedure or report. (Labor and delivery support.) (3) Perinatal Visit Payments. For MassHealth providers of doula services, the payment for perinatal visits will not exceed $800 per perinatal period per member, with the exception of payment for additional perinatal visits for which a provider receives prior authorization in accordance with 130 CMR 463.000.