Billing for adolescent and maternal depression screening

Frances Chalmers, MD, FAAP
Trustee, Washington Chapter of the American Academy of Pediatrics

The WCAAP legislative committee, health care transformation committee, staff and Chapter members have been advocating tirelessly in support of behavioral health integration in primary care.  A 2017 success was obtaining reimbursement for mental and behavioral health screening services within the scope of routine preventive primary care visits on Apple Health for Kids. Two approved services, maternal and adolescent depression screening, which have been well established as part of the Bright Futures Periodicity Schedule as standard of care components of well child visits, are now approved and covered services in Washington State. This month the Health Care Authority published its 2018 fee schedule for these services.

A maternal depression screening tool, such as the Edinburgh, is to be done at 1, 2, 4, and 6 months of age as part of an infant’s well child visit and should be billed for using the infant’s ID and the CPT code 96161. The Medicaid reimbursement for this procedure is $2.90 for both facility and non-facility encounters. While these rates are low, financial acknowledgment of the service is an important lever to increasing reliable and universal screening for adolescents and new mothers

An adolescent depression screening tool, for example the PHQ 2 or the PHQ 9, is to be done at well child visits from 12 through 21 years, using CPT code 96127. The Medicaid reimbursement for this procedure is $3.51 for both facility and non-facility encounters. Though Bright Futures standard of care is to screen through age 21, Medicaid will only reimburse through age 18.

Stay tuned for discussion of the implementation of additional mental health services and coding opportunities within a primary care setting. For more information regarding these and additional mental health service codes in the 2018 fee schedule visit this page on the HCA website.


 UP: Don’t miss free WCAAP training sessions on adolescent and maternal depression screening in Vancouver, Yakima, Tacoma, and Olympia. Our sincere thanks to Amerigroup for sponsoring these free training events, making it possible for us to bring this education to our members across the state!