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Mental Health and Substance Abuse Screening, Preventive Mental Health Counseling, and Substance Abuse Intervention for Pregnant Women: A New Benefit Under BadgerCare Plus and Wisconsin Medicaid
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Mental health and substance abuse screening, preventive mental health counseling and substance abuse intervention is a new benefit for pregnant women enrolled in BadgerCare Plus and Wisconsin Medicaid. The screening identifies women at risk for mental health or substance abuse problems, and brief counseling or intervention is provided to women identified as at risk. These services require no prior authorization, are not subject to copayment, and do not count toward other service limitations or prior authorization thresholds.
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What to do
Action · 15 steps
01Bill the screening as HCPCS H0002 with modifier HE for mental health or modifier HF for substance abuse, limited to one unit per member per pregnancy, with ICD-9-CM diagnosis V28.9.
02Bill preventive mental health counseling as H0004 with modifier HE, and substance abuse intervention as H0004 with modifier HF, with ICD-9-CM diagnosis V65.4.
03Each H0004 unit equals 15 minutes, limited to 16 units (four hours) per member per pregnancy and four units per date of service.
04Counseling or intervention must be on the same date of service as the screening or a later date, and a screening must be administered on or before that date of service.
05Services are covered during the pregnancy and up to 60 days postpartum.
06Place of service codes allowed are 03, 11, 12, 21 (not for substance abuse counselors or Master's-level mental health providers), 22, 23 and 99.
07Confirm the rendering provider type is eligible for each service using Attachment 1; for example, nurse midwives may bill screening and substance abuse intervention but not mental health counseling.
08Use an in-depth evidence-based tool to identify at-risk women; no specific tool is required, and more than one tool may be used.
09Provider types must be certified or licensed, or work under the direction of a licensed professional, and non-licensed individuals must have appropriate training or training and work experience.
10Retain documentation that the member was pregnant on the date of service, keep a copy of completed screening tools in the member file, and for non-licensed staff keep documents on education, training and supervision.
11Women who already have a mental health or substance abuse diagnosis, or who are already receiving treatment through mental health, substance abuse or prenatal care coordination services, are not the intended population.
12Refer women identified as likely to have mental health disorders, or likely to be dependent on alcohol or other drugs, to an appropriate certified mental health or substance abuse program.
13Women enrolled in an HMO must receive these services through the HMO.
14Reimbursement is the lesser of usual and customary charge or the maximum allowable fee: $35.00 flat rate for H0002, and per-15-minute rates for H0004 that vary by provider type (for example, $20.03 for physicians and psychiatrists and $14.55 for nurse practitioners).
15Check current applicability with Wisconsin Medicaid before relying on this information.
Codes mentioned
H0002H0004V28.9V65.4
Original notice
Mental Health and Substance Abuse Screening, Preventive Mental Health Counseling, and Substance Abuse Intervention for Pregnant Women: A New Benefit Under BadgerCare Plus and Wisconsin Medicaid
forwardhealth.wi.gov · Always check the source before changing claims.
Related changes
See all Wisconsin Medicaid (ForwardHealth) changes →Claims Submission Information for Expanded School-Based ServicesMay 15, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 1, 2, and 4.MediumEffective Aug 11, 2025 · Medical PolicyFamily Care begins in February of 2000, Pregnant women benefit from Presumptive Eligibility, Automated Voice Response system helpful hints, What's new on the Medicaid web siteMediumEffective Feb 1, 2000 · Medical Policy2019 CPT and HCPCS Procedure Code ChangesMediumEffective Jan 1, 2019 · CodingBrowse every Wisconsin Medicaid (ForwardHealth) change in the policy list