The Fidelis Care Blog

Effective October 1, 2022, Medicaid Managed Care (MMC) plans will reimburse postpartum maternal depression screening using a validated screening tool up to four times within the first 12 months after the end of the pregnancy.

Screening can be provided by the maternal health care provider and/or by the infant’s health care provider. This reimbursement is in addition to the payment for an Evaluation and Management (E&M) service when maternal depression screening is provided postpartum. Providers of infant health care may bill for postpartum maternal depression screening under the infant’s Medicaid ID.  Alternatively, providers may bill this service separately under the mother’s Medicaid ID.

The Current Procedural Terminology (CPT) codes to be used for maternal depression screening include the following:

• G8431 in conjunction with the HD modifier for a positive depression screen of the mother; documentation of a follow-up plan is required
• G8510 in conjunction with the HD modifier when the screening returns a negative result; a follow-up plan is not required.

If the mother screens positive for depression, the mother must be further evaluated for diagnosis and treatment. Medical practices that do not have the capacity to evaluate and treat mothers who screen positive for depression must have a referral process in place.

To view depression screening and referral tools, providers can also refer to the Updated Billing Guidance for Postpartum Maternal Depression Screening article for more detailed information.