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 first, second, fourth, and sixth month wellness visits.

According to the American College of Obstetricians and Gynecologists (ACOG) postpartum depression occurs in between 11% and 18% of new mothers. This percentage jumps to 25% among low-income parents. ACOG also notes Postpartum Depression (PPD) has a higher prevalence among people whose childbirth is paid for by Medicaid (17%) and highlights the importance of screening new mothers for PPD during their baby’s well visits, especially since up to 40% of women don’t attend their postpartum care visit.

Per the American Academy of Pediatrics, Children with mothers who have postpartum depression are more likely to have:

• Impaired social interactions
• Language delay
• Insecure attachment
• Developmental delays
• 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: 267-426-1776

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

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

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.