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Provider Notice issued 05/05/2026
Maximum Daily Quantity Limits for Non-Physician Prenatal Patient Education, Postpartum Parenting Education, Advocacy and Connection to Appropriate Resources, and Doula Support During or After Miscarriage or Abortion Units of Service
| To: |
Enrolled Doula Providers |
| Re: |
Maximum Daily Quantity Limits for Non-Physician Prenatal Patient Education, Postpartum Parenting Education, Advocacy and Connection to Appropriate Resources, and Doula Support During or After Miscarriage or Abortion Units of Service |
| Date: | May 5, 2026 |
This notice serves to inform Medicaid-Certified Doula providers that the Illinois Department of Healthcare and Family Services (HFS) has established limitations for units of services for certain doula services. This change applies to claims billed for participants covered under fee-for-service as well as the HealthChoice Illinois Plans.
Effective May 1, 2026, the Department will implement limits on the number of daily units for doula services under the following procedure codes:
Procedure Code
|
Description
|
Unit Limits
|
S9445
|
Non-physician Prenatal Patient Education
|
Daily limit of two (2) hours (8 units- billable in 15 min increments per unit) for individual prenatal educational sessions.
|
S9444
|
Postpartum Parenting Education, Advocacy and Connection to Appropriate Resources
|
Daily limit of four (4) hours (16 units - billable in 15 min increments per unit) for individual prenatal and postpartum educational sessions,
|
S9445*HQ
S9444*HQ
|
Non-physician Prenatal Patient Education
Postpartum Parenting Education, Advocacy and Connection to Appropriate Resources
Group (2+ individuals)
|
A daily limit of two (2) hours (8 units -billable in 15 min increments per unit) for group prenatal and postpartum educational sessions.
|
T1032
|
Doula support during or after miscarriage or abortion
|
Daily limit of two (2) hours (8 units- billable in 15 min increments per unit) for Medicaid customers that experience a loss due to miscarriage or have an abortion.
|
All Medicaid enrolled providers must document in the Medicaid customer’s medical record, the start and end time of each covered service or encounter on the date of service. Time documentation must reflect the duration of the service rendered and shall be recorded in hours and minutes. Medical records missing start and end times will be considered incomplte and may be subject to an audit, recoupment, or other corrective action.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.
Laura Phelan, Administrator
Division of Medical Programs