Screening and Billing for Maternal Depression

Maternal Depression Screening is included in the Pennsylvania Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Periodicity Schedule. The screening should be completed as a part of the baby’s 1, 2, 4, and 6-month well visits. As you may know, postpartum depression occurs in up to 20% of women who have recently given birth, and it is estimated that fewer than half of the cases are recognized. Studies have found that postpartum depression is more common among women who are disadvantaged and is highly prevalent in low-income black mothers. Since up to 40% of women don’t attend their postpartum care visit, it is particularly important to screen new mothers for postpartum depression as part of their baby’s well visits. 

Children with mothers who have postpartum depression are more likely to have:

• Poor infant self-regulation
• Insecure attachment
• Developmental delays
• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety disorder
• Conduct disorder

Screening for postpartum depression increases opportunities for identification and intervention for both mother and baby.

Billing:

All EPSDT screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

• 1 month to 11 month EPSDT visit CPT Code is 99381 or 99391.
  • Modifier 52 should be appended when someone other than the child’s mother brings the child to the visit and the screening is unable to be completed.

• The CPT code for Maternal Depression Screening is 96161.

Providers are encouraged to be familiar with their community resources available for mothers who may test positive on a maternal depression screening. One resource available for providers is the Perinatal Telephonic Psychiatric Services (Perinatal TiPS) Program:

• Southwest/Northwest – Children’s Community Pediatrics: 844-972-8477
• Lehigh Cap / Northwest – Penn State Children’s Hospital: 800-233-4082
• Southeast – Children’s Hospital of Philadelphia: Call 267-426-1776 for more information.

For resources on Validated Screening Tools for Maternal Depression Screening, please refer to our provider website. Additional information can be found on the Postpartum Support International website.

In Allegheny County, a child with a primary care giver who is at risk for depression or other mental health diagnosis can receive At Risk Tracking Services through Early Intervention. This referral can be made by calling the Alliance at 412-885-6000.

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.

For information about the Maternal Home Visitation Programs, please click here.