Under the DHCS standing recommendation, you can bill one initial 90-minute visit, up to eight additional visits in any combination of prenatal and postpartum, support during labor and delivery, and up to two extended three-hour postpartum visits. A second recommendation adds up to nine more postpartum visits.
That works out to 12 billable encounters under the standing recommendation, and up to 21 with a second recommendation. Here is what sits behind those numbers.
The visit allowance at a glance
| Service | How many | Recommendation needed |
|---|---|---|
| Initial visit, 90 minutes | 1 | Standing recommendation |
| Additional visits, prenatal or postpartum in any combination | Up to 8 | Standing recommendation |
| Labor and delivery support, including stillbirth, or abortion or miscarriage support | 1 per pregnancy | Standing recommendation |
| Extended three-hour postpartum visits | Up to 2 | Standing recommendation |
| Additional postpartum visits | Up to 9 | Second recommendation required |
The 12 and 21 totals are arithmetic on the components above. DHCS publishes the individual limits, not a headline total.
You do not need to chase a recommendation for the first set
Doula services are a preventive benefit, so federal rules require a written recommendation from a physician or other licensed practitioner. To remove that barrier, the DHCS Medical Director issued a statewide standing recommendation covering any Medi-Cal member who is pregnant or was pregnant within the past year.
That standing recommendation covers the initial visit, the eight additional visits, labor and delivery support, and the two extended postpartum visits. Members do not need to obtain anything separately. Reference the standing recommendation in your records for that member.
The two extended three-hour postpartum visits are included in that standing set. They do not require extra criteria or a separate recommendation, and they are the most commonly unbilled service in the doula benefit.
The ninth visit onward works differently
Once a member has used the visits under the standing recommendation, up to nine additional postpartum visits become available. Those require a new recommendation from a physician or other licensed practitioner acting within their scope of practice.
Three details matter here.
The standing recommendation cannot be used for the additional postpartum visits. DHCS states this directly.
The recommendation can be noted in the member’s medical record by the recommending provider, or the member can ask a licensed provider to complete the Medi-Cal Doula Services Recommendation: Additional Postpartum Visits form and hand the signed form to the doula.
The recommending provider does not need to be enrolled in Medi-Cal, and does not need to be in the member’s managed care plan network. Any licensed practitioner acting in scope can write it.
Get the recommendation before the visit happens. A recommendation dated after the service does not retroactively make that visit billable.
All eight visits can be used after the birth
For Medi-Cal, the postpartum period runs up to one year after pregnancy. If a member did not have a doula while pregnant, they may use the initial visit and all eight additional visits during the postpartum period, and then up to nine more with a second written recommendation.
This matters for doulas taking postpartum-only referrals. You are not working from a reduced allowance because the prenatal window has closed.
The daily rules that cap what you can actually bill
The totals above are per pregnancy. These rules govern what you can bill on any given date.
- All visits are limited to one per day, per member
- Only one doula may bill for a visit to the same member on the same day, excluding labor and delivery
- One prenatal visit or one postpartum visit may be billed on the same calendar day as labor and delivery, abortion or miscarriage support, and that visit may be billed by a different doula
- The two extended three-hour postpartum visits must be on separate days
- Labor and delivery support, miscarriage support and abortion support are each limited to once per pregnancy
There are no place of service restrictions. Home, office, hospital or alternative birthing center are all billable the same way.
Managed care plans can document this differently
Every limit above is the Medi-Cal standard. Plans generally mirror it, but their published guidance is not always identical.
Kaiser Permanente’s doula claims guidance, for example, describes the eight additional visits as one-hour visits of at least 60 minutes. DHCS does not publish a minimum duration for those eight. If you bill a plan, work from that plan’s provider manual and confirm anything that differs from the state rule in writing.
This is also why the same visit can pay differently depending on the member’s plan. Your rate is whatever your Network Provider Agreement says, not the state fee-for-service rate.
Where visit limits turn into denials
The limits themselves are simple. The denials come from three places: a second visit billed on the same date, a ninth-and-beyond postpartum visit billed without the second recommendation on file, and two doulas billing the same member on the same day.
Track visits per member per pregnancy, not per month. A doula carrying a full caseload cannot hold the count in their head, and the denial arrives months after the visit when the recommendation is harder to obtain.
Claim N Billing tracks visit counts against the recommendation on file before claims go out. CNB reduces denials by 40% for the practices we bill.
For help with doula claims, see our doula billing services. If claims are already denying, see denial management and appeals. If you are still working on plan contracts, read our complete guide to insurance credentialing for doulas and the Kaiser doula contracting update.
Questions about your visit counts
If you are unsure how many visits you can still bill for a member, or claims are denying on limits, we will look at it. Book a free billing audit, call 949-969-4397, or email info@claimnbilling.com.