Provider Alert! Behavioral Health Screening Reminders

Attention: Primary Care Providers and Obstetric Care Providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan would like to remind Primary Care Providers and Obstetric Care Providers of the importance of screening for depression during the office visit. Mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. Timely mental health interventions at an early age can aid a child before problems interfere with other developmental needs. These factors are why we at Texas Children’s Health Plan deem it vitally important to provide mental health education and resources to support our members and provider network.

How this impacts providers: Texas Health Steps benefits cover screening for postpartum depression and adolescent (ages 12-18) mental health. Providers can receive reimbursement for screening using an approved screening tool. This reimbursement is available annually and is in addition to reimbursement for the office visit. Mothers of covered infants can be screened at the child’s office visit in the first year following delivery, regardless of the mother’s coverage status. Approved screens for adolescents include the PSC 17, PSC-35, Y-PSC, PHQ-9, PHQ-A (depression screen), CRAFFT, and PHQ-A (Anxiety, mood, substance use) Approved screens for postpartum depression are the Edinburgh Postnatal Depression Scale, PHQ-9 or Postpartum Depression Screening Scale.

Coding Information:

• For adolescent screening:
  • CPT code 96160—is administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument.
  • CPT code 96161— is administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument. The parent or caregiver of an adolescent completes the screening tools.
• For Postpartum screening:
  • CPT code G8431—screening for depression is documented as being positive and a follow-up plan is recorded.
  • CPT code G8510— screening for depression is documented as negative; no follow-up plan is required.

Next steps for providers: Providers should reference the following resources if needed for assistance in the treatment of their patients.

HHSC Texas Health Steps

TMHP Texas Health Steps

http://www.thecheckup.org/wp-content/uploads/2019/05/PHQ-9.pdf
https://www.texaschildrenshealthplan.org/sites/default/files/pdf/ADHD%20Stoplight%20Tool%202016.pdf

https://www.texaschildrenshealthplan.org/for-providers/provider-resources

Texas Children’s Health Plan Behavioral Health and Substance Abuse Hotline 1-800-731-8528

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.