NYS Medicaid Coverage of Postpartum Maternal Depression Screening
Date Issued: 9/8/2015
Effective October 1, 2015 for Medicaid Managed Care Plans, the NYS Medicaid program will provide reimbursement for postpartum maternal depression screening with referral for diagnosis and treatment as appropriate. This is in addition to the payment for an Evaluation and Management (E&M) service. Postpartum maternal depression screening using a validated screening tool may be reimbursed up to three times within the first year of the infant's life. Providers should bill the service using CPT code 99420 (The Administration and Interpretation of Health Risk Assessment Instrument - Health Hazard Appraisal).
||Administration and Interpretation of Health Risk Assessment Instrument
||Up to three times within the first year of the infant's life
Screening can be done by the mother's and/or the infant’s health care provider following the birth of the baby. The infant's primary health care provider has a unique opportunity to identify postpartum maternal depression and help prevent unfavorable developmental and mental health outcomes. Screening can be integrated into the well-child care schedule.
A maternal health care provider is defined as: a physician, midwife, nurse practitioner or other health care practitioner acting within his or her lawful scope of practice. The infant's health care provider is defined as: a physician, nurse practitioner, physician assistant, or other health care practitioner acting within his or her lawful scope of practice.
If the mother screens positive for depression, then she must be further evaluated for diagnosis and treatment. Medical practices that do not have the capacity to evaluate and treat mothers who screen positive for depression must have a referral process in place for these beneficiaries. Women with current depression or a history of major depression warrant particularly close monitoring and evaluation.
Billing Guidance for Medicaid Managed Care
If the infant’s primary care provider is within the mother’s Medicaid Managed Care Plan (MMCP) network, the MMCP will reimburse for maternal depression screening at the infant’s primary care visit as a risk assessment for the mother. When a mother receives maternal depression screening services on the same day as the infant’s primary care visit, the provider should submit two separate claims. The infant’s services are billed to the health plan providing coverage for the infant, while the mother’s screening services are billed separately to the mother’s MMCP. However, if the infant is in a different MMCP than the mother, and the infant’s provider is not in the mother’s MMCP network, the screening would not be covered unless the mother’s MMCP agreed to an out of network arrangement with the infant’s provider.
Maternal depression screening performed by the mother’s primary care provider or obstetrician is also a plan-covered service. Providers will be reimbursed for maternal depression screening as a separate and distinct payment and in addition to the Evaluation and Management payment. Providers should follow the billing procedures and requirements of the mother’s managed care plan, including for the use of CPT code 99420 (The Administration and Interpretation of Health Risk Assessment Instrument - Health Hazard Appraisal) for maternal depression screening.
Screening and Referral Tools
There are multiple, validated depression screening tools available that can usually be completed in less than 10 minutes. Some examples include the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9).
Please visit the following link for additional information on validated screening tools for maternal depression: http://www.health.ny.gov/community/pregnancy/health_care/perinatal/
Please refer to the following links for helpful referral information: