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Effective for claims with dates of service on and after April 1, 2024, the Health Care Authority’s (HCA) caregiver depression screening policy allows for up to two caregiver depression screenings per well-child checkup for infants age 12 months and younger.
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- Qualified Apple Health providers defined in the EPSDT Well-Child Program
Which codes are impacted?
These changes apply to CPT® screening code 96161.
CPT is copyright © 2022 American Medical Association. All rights reserved.
Why did HCA change the policy?
Recognizing the importance of screening for mental health needs for all caregivers attending infant well-child checkups, Apple Health providers identified the current Medically Unlikely Edit (MUE)* for 96161 as a barrier to providers screening birthing people and co-parents that attend visits with their infant.
As a response, HCA partnered with Centers for Medicare and Medicaid Services (CMS) to request the MUE be deactivated and allow for up to two screenings at each visit.
*Visit CMS National Correct Coding Initiative (NCCI) webpage to learn more about Medically Unlikely Edits (MUEs).
Where can I learn about billing for this new policy?
Access the EPSDT Well-child program billing guide at HCA’s provider billing guides and fee schedule webpage for more details about these policies and additional updates.
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