Postpartum Maternal Depression Screening: Updated Billing Guidance

Date Issued: 11/30/2016

Effective November 1, 2016, New York State Medicaid Managed Care will allow providers of infant healthcare to bill for postpartum maternal depression screening under the infant's Medicaid identification number. Also, the current CPT code used for maternal depression screening (99420) will be replaced with the following:

  • G8431 (with HD modifier) – Screening for clinical depression is documented as being positive and a follow-up plan is documented
  • G8510 (with HD modifier) – Screening for clinical depression is documented as negative, a follow-up plan is not required

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. This reimbursement is in addition to the payment for an Evaluation and Management (E&M) service. Screening can be provided by the mother's healthcare provider and/or by the infant's healthcare provider following the birth of the baby. This service can be integrated into the well child care schedule.

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. The current standard of care for pregnant women requires that all pregnant women receive depression screening as part of their routine antepartum care. Maternal depression screening that occurs antepartum is considered to be included in the payment for the E&M service.

A maternal healthcare provider is defined as a physician, midwife, nurse practitioner, physician assistant, or other healthcare practitioner acting within his or her lawful scope of practice. The infant's healthcare provider is defined as a physician, nurse practitioner, physician assistant or other healthcare practitioner acting within his or her lawful scope of practice.

Screening and Referral Tools

There are multiple, validated depression screening tools available for use. These tools usually allow the screening to be completed in less than 10 minutes. Some examples of recommended screening tools include the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9).

Please refer to the following for validated maternal depression screening tools and referral information:

Billing Guidance

If maternal depression screening is provided postpartum by the maternal health care provider, the service can be reimbursed in addition to the E&M visit. Providers should bill for this service using CPT code G8431 in conjunction with the HD modifier for a positive depression screen of the mother and G8510 in conjunction with the HD modifier when the screening returns a negative result. These two new G series codes replace CPT code 99420 (The Administration and Interpretation of Health Risk Assessment Instrument - Health Hazard Appraisal) currently being used for maternal depression screening.

If maternal depression screening is performed on the same day as the infant's primary care visit (E&M) by the infant's health care provider, one claim can be submitted for both services using the appropriate G series code (G8431/G8510) with the HD modifier under the infant's Medicaid identification number. Alternatively, providers may bill this service separately under the mother's Medicaid identification number.

Reminders
  • New York State Medicaid record keeping requirements apply to all services offered and provided to beneficiaries.
  • HIPAA-compliant consent to treat and share information necessary for treatment is the responsibility of all providers. Medical providers who have additional questions about requirements should consult with their own counsel.