By Joy Burkhard, MBA
Founder and Executive Director, 2020 Mom
In July 2019, the California Medicaid (Medi-Cal) Agency, Department of Health Care Services (DHCS) announced how it would support health plan compliance with the US Preventive Services Task Force assessment of sufficient evidence and recommendation to screen and treat to prevent maternal depression. Read more here.
Other states are likely developing similar positions to provide clarity to Medicaid health plans and screening and treating providers on how services should be billed and covered.
5. Counseling to Prevent Perinatal Depression is Now Reimbursable
Effective for dates of service on or after February 12, 2019, and consistent with the U.S. Preventive Services Task Force recommendation, Medi-Cal will now reimburse individual and/or group counseling sessions for pregnant or postpartum women with certain depressive, socioeconomic and mental health related risk factors. These risk factors include perinatal depression, a history of depression, current depressive symptoms (that do not reach a diagnostic threshold), low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety symptoms and a history of significant negative life events.
Up to a combined total of 20 individual counseling (CPT codes 90832 and 90837) and/or group counseling (CPT code 90853) sessions are reimbursable when delivered during the prenatal period and/or during the 12 months following childbirth. Modifier 33 must be submitted on claims for counseling given to prevent perinatal depression.
This information is reflected in the following provider manuals (see updated pages):
2020 Mom is supporting these efforts by promoting training of the evidenced based ‘Mothers and Babies’ Prevention model developed at the University of California at San Francisco. Learn more about the program by downloading our webinar slides and/or watching the webinar recording here.