Provider Alert! Screening for Maternal Depression – Essential to Child Well-Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based on the reimbursement for code 99420 in the current Medicaid fee schedule until the Medicaid fee schedule is updated to reflect code 96161.

In 2016, CMS issued an informational bulletin discussing the importance of early screening for maternal depression. Maternal depression is a serious and prevalent condition that not only affects the mother, but may present a substantial early risk to appropriate child development, the mother-infant bond, and the family. According to the AAP, it has been estimated that 5 percent to 25 percent of all pregnant, postpartum and parenting women have some type of depression. Mothers who have low incomes are more likely to experience some form of depression than the general population of mothers. A maternal depression screening can be considered an essential part of a risk assessment for the child, given the evidence that maternal depression can place children at risk of adverse health consequences.

Screening for postpartum depression does not require that the child’s provider treat the mother. However, the child’s provider has a role in supporting the mother and facilitating her access to resources to optimize the child’s healthy development and the healthy functioning of the family. Mothers who screen positive for postpartum depression may be referred to their Primary Care Provider for treatment. National Hotlines are also available to provide guidance for treatment:

Postpartum Support International Warmline

Phone Number: 800-944-4PPD (4773)

Website: www.postpartum.net

PPD Moms

Phone Number: 800-PPD-MOMS (800-773-6667)

Email: info@hopeline.com

Website: http://www.1800ppdmoms.org/

Providers may access the Edinburgh Postnatal Depression Scale online at no cost:

English: https://www2.aap.org/sections/scan/practicingsafety/Toolkit_Resources/Module2/EPDS.pdf

Spanish: http://www.cdph.ca.gov/programs/mcah/Documents/MO-CHVP-EPDS-Spanish.pdf

For additional information:

AAP Clinical Report – Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice accessible at http://pediatrics.aappublications.org/content/pediatrics/early/2010/10/25/peds.2010-2348.full.pdf

CMS Informational Bulletin – Maternal Depression Screening and Treatment: A Critical Role for Medicaid in the Care of Mothers and Children accessible at

https://www.medicaid.gov/federal-policy-guidance/downloads/cib051116.pdf