Author: Clinical Policy and Programs, DMA, 919-855-4260
Appropriate maternal depression screening is necessary to ensure that postpartum depression is addressed and care is administered in a timely manner to improve quality of care and long-term outcomes for both mother and child. Maternal depression screening identifies mothers who may be suffering from depression and may lead to treatment or discussion of referral strategies for appropriate treatment.
Obstetric providers may be reimbursed for three units of CPT code 96127 – brief emotional/behavioral assessment [e.g., depression inventory, attention-deficit hyperactivity disorder (ADHD) scale], with scoring and documentation, per standardized instrument – during the first year after the delivery date or until the recipient’s eligibility ends, in addition to global obstetrics and postpartum package services.
Note: Medicaid for Pregnant Women (MPW) eligibility ends the last date of the month in which the 60th post-delivery day occurs.
Total reimbursable units for the first year after delivery or until the mother’s eligibility ends should be three units. If a problem is identified, the mother should be referred to their primary care provider or other appropriate providers. Providers performing this postpartum depression screening will be required to bill diagnosis Z13.89 (encounter for screening for other disorder) in combination with the CPT code 96127.
For more information, providers should refer to DMA’s Obstetrics and Gynecology Clinical Coverage Policy web page. Providers with questions can contact the CSRA Call Center at 1-800-688-6696 or NCTracksprovider@nctracks.com.