diff --git a/homeassistant/components/alexa/state_report.py b/homeassistant/components/alexa/state_report.py
index d3e476c2e8c..783397ca047 100644
--- a/homeassistant/components/alexa/state_report.py
+++ b/homeassistant/components/alexa/state_report.py
@@ -86,7 +86,9 @@ async def async_enable_proactive_mode(hass, smart_home_config):
             return
 
         if should_doorbell:
-            if new_state.state == STATE_ON:
+            if new_state.state == STATE_ON and (
+                old_state is None or old_state.state != STATE_ON
+            ):
                 await async_send_doorbell_event_message(
                     hass, smart_home_config, alexa_changed_entity
                 )
diff --git a/tests/components/alexa/test_state_report.py b/tests/components/alexa/test_state_report.py
index b2d36b9d179..bb61cea2413 100644
--- a/tests/components/alexa/test_state_report.py
+++ b/tests/components/alexa/test_state_report.py
@@ -346,7 +346,11 @@ async def test_doorbell_event(hass, aioclient_mock):
     hass.states.async_set(
         "binary_sensor.test_doorbell",
         "off",
-        {"friendly_name": "Test Doorbell Sensor", "device_class": "occupancy"},
+        {
+            "friendly_name": "Test Doorbell Sensor",
+            "device_class": "occupancy",
+            "linkquality": 42,
+        },
     )
 
     await state_report.async_enable_proactive_mode(hass, get_default_config(hass))
@@ -354,7 +358,21 @@ async def test_doorbell_event(hass, aioclient_mock):
     hass.states.async_set(
         "binary_sensor.test_doorbell",
         "on",
-        {"friendly_name": "Test Doorbell Sensor", "device_class": "occupancy"},
+        {
+            "friendly_name": "Test Doorbell Sensor",
+            "device_class": "occupancy",
+            "linkquality": 42,
+        },
+    )
+
+    hass.states.async_set(
+        "binary_sensor.test_doorbell",
+        "on",
+        {
+            "friendly_name": "Test Doorbell Sensor",
+            "device_class": "occupancy",
+            "linkquality": 99,
+        },
     )
 
     # To trigger event listener
@@ -386,6 +404,34 @@ async def test_doorbell_event(hass, aioclient_mock):
     assert len(aioclient_mock.mock_calls) == 2
 
 
+async def test_doorbell_event_from_unknown(hass, aioclient_mock):
+    """Test doorbell press reports."""
+    aioclient_mock.post(TEST_URL, text="", status=202)
+
+    await state_report.async_enable_proactive_mode(hass, get_default_config(hass))
+
+    hass.states.async_set(
+        "binary_sensor.test_doorbell",
+        "on",
+        {
+            "friendly_name": "Test Doorbell Sensor",
+            "device_class": "occupancy",
+        },
+    )
+
+    # To trigger event listener
+    await hass.async_block_till_done()
+
+    assert len(aioclient_mock.mock_calls) == 1
+    call = aioclient_mock.mock_calls
+
+    call_json = call[0][2]
+    assert call_json["event"]["header"]["namespace"] == "Alexa.DoorbellEventSource"
+    assert call_json["event"]["header"]["name"] == "DoorbellPress"
+    assert call_json["event"]["payload"]["cause"]["type"] == "PHYSICAL_INTERACTION"
+    assert call_json["event"]["endpoint"]["endpointId"] == "binary_sensor#test_doorbell"
+
+
 async def test_doorbell_event_fail(hass, aioclient_mock, caplog):
     """Test proactive state retries once."""
     aioclient_mock.post(