USPSTF Perinatal Depression Prevention Counseling coverage
Customize your policy alerts
Sign up for all Highmark Delaware policy alerts
Know when Highmark Delaware releases new policies or updates existing guidance.
Monitor payer policy activity
Guidance for implementation and billing of USPSTF-recommended perinatal depression prevention counseling for pregnant and postpartum individuals without current depression, applicable to Highmark Delaware members; providers should verify individual member benefits via Availity.
No material clinical or coverage changes in this revision.
Coverage Criteria for Preventive Perinatal Depression Counseling
Coverage criteria for preventive perinatal depression counseling
Covered when ALL of the following are met:
ALL of the following
- Patient is pregnant or <1 year postpartum
- No current psychiatric or depression diagnosis code on the claim/encounter
- Patient is identified as at increased risk for perinatal depression (per USPSTF risk factors such as history of depression, current subthreshold depressive symptoms, socioeconomic risk factors, recent intimate partner violence, elevated anxiety symptoms, history of negative life events, family history of depression, history of physical or sexual abuse, unplanned or unwanted pregnancy, current stressful life events, pregestational or gestational diabetes, or pregnancy complications)
- Documentation on the claim includes an appropriate screening/encounter code (e.g., Z13.32, Z86.59, or Z87.898) AND a pregnancy or postpartum diagnosis code (e.g., Z34.* or Z39.2)
- Bill appropriate preventive counseling or behavioral health procedure codes (examples: 99401-99404; 96156; 96158-96159; 96167-96171; group counseling codes 96464-96465). Omit codes that indicate drug management, since the service is for persons without a current depression diagnosis
- Verify individual member coverage and any plan-specific restrictions via Availity before billing
Diagnosis and Procedure Codes; Frequency Guidance
| Z13.32 | Encounter for screening for maternal depression — perinatal/postpartum |
| Z86.59 | Personal history of other mental and behavioral disorders |
| Z87.898 | Personal history of depression including perinatal problem |
| Z34.0 | Encounter for supervision of normal first pregnancy |
| 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 |
| Z34.9 | Encounter for supervision of normal pregnancy, unspecified |
| Z34.93 | Encounter for supervision of normal pregnancy, third trimester |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) — individual; 15 min |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) — individual; 30 min |
| 99403 | Preventive medicine counseling and/or risk factor reduction intervention(s) — individual; 45 min |
| 99404 | Preventive medicine counseling and/or risk factor reduction intervention(s) — individual; 60 min |
| 96158 | Health behavior intervention, individual |
| 96159 | Health behavior intervention, individual (add-on/other) |
| 96156 | Health behavior assessment |
| 96167 | Family/couple behavioral health intervention with patient present |
| 96168 | Family/couple behavioral health intervention with patient present (other) |
| 96170 | Family/caregiver behavioral health interventions without patient present |
Provider Billing and Verification Actions
Verify benefits and document appropriate screening/pregnancy codes when billing preventive perinatal counseling
Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression (and who do not have a current diagnosis of depression) to counseling interventions; document the appropriate screening/encounter and pregnancy/postpartum diagnosis codes (e.g., Z13.32, Z86.59, Z87.898 with Z34.* or Z39.2) on the claim and bill applicable preventive counseling CPT/behavioral CPT codes (for example 99401–99404, 96156, 96158–96159, 96167–96171, 96464–96465). Verify the individual member's covered services and any plan-specific restrictions via Availity before billing.
- Target only pregnant persons and persons <1 year postpartum without a current depression diagnosis who are at increased risk.
- Include a screening/encounter diagnosis (e.g., Z13.32, Z86.59, Z87.898) AND a pregnancy/postpartum diagnosis (Z34.* or Z39.2) on the claim.
- Bill preventive counseling codes only (exclude codes indicating drug management).
- Confirm member-specific coverage and restrictions through Availity prior to submitting claims.
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.