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KMAP BULLETIN: Maternal Depression Screenings

Date: 01/13/21

KMAP GENERAL BULLETIN 20263 (PDF)

Effective with dates of service on and after January 1, 2021, Maternal Depression Screenings are reimbursable using the Current Procedural Technology (CPT) and Health Care Common Procedure Coding System (HCPCS) codes 96160, 96161, G8431, and G8510 when using one or more of the following validated screening tools:

  • Edinburgh Postnatal Depression Scale (EPDS)
  • Perinatal Grief Intensity Scale (PGIS)
  • Postpartum Depression Screening Scale (PDSS)
  • Patient Health Questionnaire 9 (PHQ-9)
  • Beck Depression Inventory II (BDI-II)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)

These screenings are reimbursable up to three times when a woman is pregnant or after a perinatal loss (stillbirth, miscarriage or neonatal death) that occurs during her Medicaid coverage period, and up to five times postpartum up until the child is 12 months of age. Any screenings that occur prior to the birth of the child or after a perinatal loss, should be billed under the woman’s Medicaid Identification (ID) number using CPT code 96160. Any screening that occurs after the child is born is considered an Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit per Centers for Medicare and Medicaid Services (CMS) guidance and should be billed under the infant’s Medicaid ID number, using CPT code 96161. If the child does not have an assigned Medicaid ID number, CPT code 96161 can be billed under the mother’s Medicaid ID number for up to 45 days postpartum. Rural Health Care/Federally Qualified Health Centers (RHC/FQHC) may perform these screenings and list this on their claims, but it will be included in the encounter rate.

Note: The effective date of the policy is January 1, 2021. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.