CurrentHighmark Blueshield NenyPolicy N/A

Perinatal depression prevention counseling coverage

Defines Highmark's preventive coverage approach and coding guidance for USPSTF-recommended counseling interventions to prevent perinatal depression in pregnant and persons up to 1 year postpartum who are at increased risk, and instructs providers to verify member benefits via Availity.

Policy Summary

PayerHighmark Blueshield Neny

PolicyPerinatal depression prevention counseling coverage

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2020

Next Review DateN/A

Key ActionVerify individual member's health benefit plan via Availity to determine coverage for preventive perinatal depression counseling.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1.1.2020policy effective date

20frequency noted

pregnant/<1yr postpartumpopulation

Coverage Criteria for Perinatal Depression Prevention

Perinatal depression prevention coverage criteria

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Covered when ALL of the following are met:

ALL of the following

Member is pregnant (Z34 series) OR is less than 1 year postpartum (Z39.2) WITHOUT any psychiatric or current depression diagnosis codepregnant or <1 year postpartum
AND one of the following risk/identification criteria:
- Screening code for maternal depression is present (Z13.32)
- Personal history codes indicating elevated risk are present (Z86.59 or Z87.898)
- Documentation of increased-risk features per USPSTF (examples include history of depression or subthreshold depressive symptoms; socioeconomic risk such as low income, adolescent or single parenthood; recent intimate partner violence; elevated anxiety symptoms; history of significant negative life events; personal/family history of depression; history of physical or sexual abuse; unplanned/unwanted pregnancy; current stressful life events; pregestational or gestational diabetes; pregnancy complications)
Counseling is billed with preventive counseling CPT codes (99401–99404) or behavioral counseling/assessment codes (96156, 96158–96159, 96164–96165, 96167–96168, 96170–96171) and does NOT include codes for drug management (drug management codes excluded for this preventive population)
Providers verify individual member benefit coverage via Availity as plan-level benefits determine coverage; mental health treatment for diagnosed depression is covered under the member's medical benefits

Diagnosis and Counseling Codes

Covered ICD-10 CodesICD-10Covered

Z13.32	Encounter for screening for maternal depression (perinatal/postpartum)
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
Z34.80	Encounter for supervision of other normal pregnancy, unspecified trimester
Z34.81	Encounter for supervision of other normal pregnancy, first trimester
Z34.82	Encounter for supervision of other normal pregnancy, second trimester

1–10 of 19

1/2

Age restriction

Age RestrictionNone

Provider Actions and Billing Guidance

Documentation Required

Verify member benefits via Availity

Verify the individual member's health benefit plan via Availity to confirm whether preventive perinatal depression counseling is a covered service; coverage is determined by the member's specific plan. The document also provides coding guidance for preventive counseling where USPSTF did not.

Check member-specific benefits on Availity before providing or billing services.
Use the coding guidance in this document for preventive counseling claims (USPSTF did not provide coding guidance).

Definitions

Increased risk — perinatal depression

DefinitionPersons who have one or more risk factors that increase likelihood of developing perinatal depression (USPSTF definition used by policy)

Included risk factorsHistory of depression; current subthreshold depressive symptoms; personal or family history of depression

Social and psychosocial factorsSocioeconomic risks (low income, adolescent or single parenthood), lack of social/financial support, recent intimate partner violence, unplanned/unwanted pregnancy

Clinical and life-event factorsElevated anxiety symptoms, history of significant negative life events, history of physical or sexual abuse, current stressful life events, pregestational or gestational diabetes, pregnancy complications (eg, preterm delivery or pregnancy loss)