MedicaidDocumentationHigh impact
Maternal Mental Health Screening Requirements
L.A. Care Health Plan·CA · OB-GYN, Family Medicine, Psychiatry +1 more·Medical Policy
Effective date
Jun 17, 2026
We identified it
Jul 1, 2026
Summary
L.A. Care revised its Maternal Mental Health Screening Requirements (effective immediately) requiring providers to conduct and document maternal mental health screenings during pregnancy (first trimester recommended) and within 6 weeks postpartum using validated tools (EPDS, PHQ-2, PHQ-9, PHQ-A), with positive screens requiring documented follow-up within 30 days. Billing teams must now use specific LOINC codes and ensure screening documentation is linked to billable CPT codes for proper claims submission and HEDIS measure reporting.
Action Required
IMMEDIATE: Billing and clinical teams must take the following actions: (1) Update EHR/billing systems to require documentation of maternal mental health screenings using ONLY these validated tools: Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), or PHQ-Adolescent (PHQ-A); (2) Ensure screening encounter forms prompt providers to document screening score AND result flag using the LOINC codes provided (55758-7 for PHQ-2, 44261-6 for PHQ-9, 89204-2 for PHQ-A, 99046-5 for EPDS); (3) Configure billing system to flag any depression follow-up claim that is NOT associated with a billable CPT code on the same encounter, as these claims will be denied; (4) Create clinical workflow requiring documented follow-up within 30 days for positive screens (PHQ-2 ≥3, PHQ-9 ≥10, PHQ-A ≥10, EPDS ≥10); (5) Train providers and front-desk staff on referral pathways: Carelon Behavioral Health at (877) 344-2858 for mild-to-moderate cases, Los Angeles County Department of Mental Health at (800) 854-7771 for high-level needs; (6) Implement ACE screening and IPV screening requirements (IPV at initial prenatal visit, each trimester, and postpartum); (7) Update claims submission process to include required data elements (Member ID, DOB, Service Date, Assessment Score, LOINC code, Result flag). Failure to document screenings and link to billable CPT codes will result in claim denials and reduced HEDIS rates (PND-E and PDS-E measures).