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 has updated its Maternal Mental Health Screening Requirements policy (effective immediately) to mandate documented depression screening during pregnancy (first trimester recommended) and within 6 weeks postpartum using validated tools (PHQ-2, PHQ-9, PHQ-A, EPDS), with specific LOINC codes and billing requirements for depression follow-up associated with billable CPT encounters. Positive screens require documented follow-up within 30 days and referral to Carelon Behavioral Health or LA County Department of Mental Health.
Action Required
Immediately (effective June 17, 2026): (1) Billing team must update EHR/billing system to require LOINC codes (55758-7, 44261-6, 89204-2, 99046-5) and corresponding PHQ/EPDS assessment scores on all prenatal and postpartum encounters for L.A. Care members. (2) Modify encounter templates and clinical documentation requirements to ensure providers document screening tool used, score obtained, and result flag (positive/negative). (3) Implement automated flag in billing system to ensure depression follow-up claims are billed only when associated with a billable CPT code encounter; claims without this linkage will be rejected. (4) Create internal audit process to track compliance with 30-day follow-up documentation requirement for positive screens. (5) Notify all OB-GYN and family medicine providers of revised documentation and billing requirements to avoid claim denials. (6) Update prior authorization/referral processes to support warm handoff to Carelon Behavioral Health (877-344-2858) or LA County DMH (800-854-7771) for positive screens. This policy supersedes the June 2, 2026 version; non-compliance will result in claim denials and potential audits.