CurrentHighmark Blueshield NenyPolicy N/A

USPSTF perinatal depression prevention counseling coverage and coding guidance

Guidance for providers on Highmark's preventive coverage and coding recommendations to implement the USPSTF recommendation for counseling to prevent perinatal depression for pregnant and postpartum persons at increased risk. Applies to claims submission and coding; coverage is subject to individual member plan benefits.

Policy Summary

PayerHighmark Blueshield Neny

PolicyUSPSTF perinatal depression prevention counseling coverage and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionWhen billing preventive perinatal depression counseling include a screening/personal history code (e.g., Z13.32, Z86.59, Z87.898) AND a pregnancy or postpartum encounter code (e.g., Z34.* or Z39.2) and use the listed counseling CPT codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1/1/2020policy effective date

20Frequency noted

NoneAge restriction

USPSTF (Feb 2019)Source referenced

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage criteria for perinatal depression prevention counseling

Covered when ALL of the following are met:

ALL of the following

Member is pregnant or is less than 1 year postpartum (per USPSTF applicability).
No current diagnosis of depression or active psychiatric diagnosis on the claim (service is for prevention, not treatment).
Member is at increased risk for perinatal depression (examples include history of depression; current subthreshold depressive symptoms; socioeconomic risk factors such as low income, adolescent or single parenthood; recent intimate partner violence; elevated anxiety symptoms; history of significant negative life events; personal or family history of depression; history of physical or sexual abuse; unplanned or unwanted pregnancy; current stressful life events; pregestational or gestational diabetes; pregnancy complications).

Required claim elements

Claim must include one of the screening/personal-history codes: Z13.32, Z86.59, or Z87.898.
AND must include a pregnancy or postpartum encounter code: one of the Z34.* series (encounter for supervision of pregnancy) OR Z39.2 (encounter for routine postpartum follow-up).
Counseling services must be billed using the listed preventive/counseling CPT codes (examples listed by Highmark include 99401–99404 for preventive medicine counseling and the behavioral/psychosocial assessment and counseling codes such as 96156, 96158–96159, 96167–96171, 96464–96465 as appropriate).

Service scope and exclusions

Services are preventive counseling interventions (studies mainly included cognitive behavioral therapy and interpersonal therapy) intended for persons without current depression; mental health treatment for active diagnoses is covered under medical benefits per the member's plan.
Check the individual member health benefit plan via Availity for specific coverage details and any limits or benefit rules.

Covered counseling and encounter codes

Covered diagnosis/encounter codesICD-10Covered

Z13.32	Encounter for screening maternal depression - perinatal/postpartum
Z86.59	Personal history of other mental and behavioral disorders
Z87.898	Personal history of depression - including perinatal
Z34	Encounter for supervision of normal pregnancy (all subcodes listed)
Z34.0	Encounter for supervision of normal first pregnancy
Z34.00	Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.01	Encounter for supervision of normal first pregnancy, first trimester
Z34.02	Encounter for supervision of normal first pregnancy, second trimester
Z34.03	Encounter for supervision of normal first pregnancy, third trimester
Z34.8	Encounter for supervision of other normal pregnancy

1–10 of 19

1/2

Covered counseling and preventive medicine CPT codesCPTCovered

99401	Preventive medicine counseling and/or risk factor reduction intervention - individual; 15 minutes
99402	Preventive medicine counseling and/or risk factor reduction intervention - individual; 30 minutes
99403	Preventive medicine counseling and/or risk factor reduction intervention - individual; 45 minutes
99404	Preventive medicine counseling and/or risk factor reduction intervention - individual; 60 minutes

Covered counseling and assessment codes (behavioral/mental health)mixedCovered

96156	Health behavior assessment
96158	Individual counseling (behavior change/risk reduction)
96159	Individual counseling (add-on/related code)
96464	Group counseling (listed)
96465	Group counseling (listed)
96167	Family counseling with patient present
96168	Family counseling with patient present
96170	Family counseling without patient present
96171	Family counseling without patient present

Study frequency

USPSTF median frequency in studies8 (USPSTF median); document notes frequency = 20

Document effective dateEffective 1.1.2020

Age restrictionNone

Coding and billing guidance for preventive perinatal depression counseling

Billing Rule

Billing rule — include screening/history plus pregnancy/postpartum encounter code when billing preventive counseling

When billing preventive perinatal depression counseling, include a screening/personal history pregnancy/postpartum diagnosis code (one of Z13.32, Z86.59, or Z87.898) AND a pregnancy or postpartum encounter code (one of the Z34.* series or Z39.2). Bill counseling using the listed CPT codes (eg, 99401–99404 and other listed counseling codes). Verify individual member coverage via Availity.

Must include one of: Z13.32, Z86.59, or Z87.898 AND a pregnancy/postpartum diagnosis code (Z34.* or Z39.2).
Use the listed preventive medicine counseling CPT codes (99401–99404) or other specified counseling codes when submitting claims.
Check the individual member's health benefit plan via Availity for covered services.

Definitions and risk criteria

Definition: "At increased risk" for perinatal depression

Primary populations coveredPregnant persons and persons <1 year postpartum who do not have a current diagnosis of depression

Key risk factors listed by USPSTFHistory of depression or personal/family history of depression; current depressive symptoms below diagnostic threshold; elevated anxiety symptoms; recent significant negative life events; history of physical or sexual abuse

Socioeconomic and social risk factorsLow income, adolescent or single parenthood, lack of social/financial support, unplanned or unwanted pregnancy

Other clinical risk factorsRecent intimate partner violence; pregestational or gestational diabetes; complications during pregnancy (eg, preterm delivery or pregnancy loss); current stressful life events