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Maternal Mental Health Screening Requirement Update
L.A. Care Health Plan·CA · OB-GYN, Family Medicine, Pediatrics·Medical Policy
Effective date
Jun 2, 2026
We identified it
Jun 20, 2026
Summary
L.A. Care Health Plan requires providers to conduct and document maternal mental health screenings during pregnancy and postpartum using validated tools like EPDS or PHQ-9, with specific billing codes for enhanced HEDIS reporting. Positive screens must have documented follow-up within 30 days and appropriate referrals within 10 days.
Action Required
Immediately: Providers must implement maternal mental health screening protocols using CPT 96127, HCPCS G0444, G8431, G8510, and ICD-10 Z13.31, Z13.32 for proper documentation and HEDIS reporting. Update EMR templates to include Edinburgh Postnatal Depression Scale (EPDS) or PHQ-9 screening tools during pregnancy (first trimester recommended), within 6 weeks postpartum, and at infant well-child visits at 1, 2, 4, and 6 months. Establish referral workflows to Carelon Behavioral Health (877-344-2858) for mild-moderate cases within 10 days and LA County DMH (800-854-7771) for high-level needs. Document all screening scores and ensure 30-day follow-up for positive screens to avoid compliance issues.