DraftHighmark Blueshield NenyPolicy N/A

Perinatal Depression Prevention Coding and Coverage Guidance

This document governs coding and coverage guidance for perinatal depression screening and counseling interventions for pregnant and postpartum individuals at increased risk, including which diagnosis and procedure codes apply. It affects providers submitting claims to Highmark BlueShield (Northeastern NY regions specified in document footer).

Policy Summary

PayerHighmark Blueshield Neny

PolicyPerinatal Depression Prevention Coding and Coverage Guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionBill counseling and behavioral health assessment services with the listed pregnancy/postpartum diagnosis codes for at‑risk pregnant and postpartum individuals without a current depression diagnosis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20listed frequency (USPSTF median comparison)

Noneage restriction

Multipleprocedure codes provided

Pregnancy/postpartum listrequired diagnosis codes

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Coverage stance and coding linkage

Covered when ALL of the following are met:

ALL of the following

Patient is pregnant or is less than 1 year postpartum (encounter must be coded with one of the listed pregnancy or postpartum diagnosis codes).
There is no current psychiatric or depression diagnosis code on the claim (intended population: persons at increased risk without a current diagnosis of depression).
The encounter is billed with one of the required pregnancy or postpartum diagnosis codes (examples include ICD codes in the 234.x series for supervision of normal pregnancy or 239.2 for routine postpartum follow-up).
The service is a counseling or health behavior assessment/intervention billed with one of the listed CPT/behavioral codes for preventive counseling or behavioral health intervention (e.g., 99401–99404; 96156; 96158–96159; 96164–96165; 96167–96168; 96170–96171).

Operational linkage: diagnosis AND procedure coding are both required for coverage of these preventive counseling services.

Diagnosis and Procedure Codes

Diagnosis codes relevant to perinatal depression screening and encountersICD-10Covered

213.32	Encounter for screening maternal depression perinatal postpartum
286.59	Personal history of other mental and behavioral disorders
287.898	Personal history of depression including perinatal problem
234	Encounter for supervision of normal pregnancy (including 234.0-234.93 variants)
239.2	Encounter for routine postpartum follow-up

Procedure codes for counseling servicesCPTCovered

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
96158	Health behavior assessment/intervention, individual
96159	Health behavior assessment/intervention, individual (parallel code)
96164	Health behavior intervention, individual (primary care and mental health)
96165	Health behavior intervention, individual (alternate)
96167	Health behavior intervention, family with patient present
96168	Health behavior intervention, family with patient present (alternate)

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Provider Billing and Documentation Actions

Billing Rule

Use specified pregnancy/postpartum diagnosis codes and listed counseling codes; exclude drug-management codes

Bill preventive counseling and behavioral health assessment services using the listed CPT/HCPCS codes when the encounter includes one of the specified pregnancy or postpartum diagnosis codes and there is no current psychiatric or depression diagnosis. Exclude codes that include drug management because the policy targets individuals at risk without a diagnosis.

Use one of the pregnancy/postpartum diagnosis codes (e.g., 234, 234.0–234.93 series, or 239.2) on the claim.
Ensure the encounter also includes an at-risk screening code (e.g., 213.32, 286.59, or 287.898) as applicable.
Submit preventive counseling codes: 99401, 99402, 99403, 99404 for primary care counseling (15–60 minute increments).
Submit health behavior assessment/intervention and related codes for primary care and mental health: 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171.
Do not bill codes that include drug management—those were intentionally excluded for this targeted, non-diagnosed population.

Key Definitions — Eligible Population

Pregnant and postpartum persons at increased risk of perinatal depression (no current diagnosis of depression; includes those <1 year postpartum with specified risk factors)

DefinitionPregnant persons and persons <1 year postpartum without a current diagnosis of depression who are at increased risk of developing perinatal depression.

Specified risk factorsHistory of depression or personal/family history of depression; current subthreshold depressive symptoms; elevated anxiety; recent stressful life events or significant negative life events; history of physical or sexual abuse; interpersonal violence; unplanned or unwanted pregnancy; pregestational or gestational diabetes; pregnancy complications (eg, preterm delivery or pregnancy loss).

Social and demographic risk factorsLow income or other socioeconomic disadvantage, lack of social or financial support, adolescent parenthood, single parenthood.

Coverage linkage (actionable)Counseling interventions are covered when the encounter is coded with one of the listed pregnancy/postpartum diagnosis codes and there is no current depression diagnosis (highlighted item).

Time windowIncludes persons who are less than 1 year postpartum.