Priority Health - Preventive Guidleline Update: Counseling Services for Pregnant and Postpartum Women

December 11, 2019

Effective Feb. 1, 2020, all commercial group and individual plans will cover counseling services as a preventive service, for pregnant and postpartum women identified as at-risk for depression.

When preventive, counseling services will be covered at 100% ahead of deductible.

Why are we making this change?

This is a national-level change driven by the United States Preventive Services Task Force (USPSTF) recommendation that clinicians provide or refer pregnant and postpartum persons who are at increased risk of depression to counseling interventions.

Identifying at-risk members

The USPSTF recommends providing counseling interventions to women with one of the following risk factors: a history of depression, current depressive symptoms (that do not reach a diagnostic threshold), certain socioeconomic risk factors such as low income or adolescent or single parenthood, recent intimate partner violence, or mental health related factors such as elevated anxiety symptoms or a history of significant negative life events.

How to bill for preventive counseling services for postpartum and pregnant women at-risk for depression:

Providers should bill for these services using the following preventive codes:

  • 96127 (Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument)
  • 99401 (Individual - 15 minute)
  • 99402 (Individual - 30 minutes)
  • 99403 (Individual - 45 minutes)
  • 99404 (Individual - 60 minutes)
  • 99411 (Group – 30 minutes)
  • 99412 (Group – 60 minutes)

If a member is already diagnosed with depression, or if mental health diagnosis is made, counseling services are no longer be considered preventive, and cost-sharing will apply depending on the member’s benefit. Providers should bill these services as therapy treatment services, rather than as preventive services.   

As with all preventive services, members must see an in-network provider for us to cover the service in full.

How is PH communicating this change?

We’ve posted a news item to our website. Updates to the preventive services pages on the Provider Manual, and member-facing preventive guidelines pages will be made prior to Feb. 1, 2020.