MedicaidDocumentationHigh impact
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 now requires providers to conduct and document maternal mental health screenings during pregnancy and up to 1 year postpartum using validated tools like EPDS or PHQ-9. Positive screens require documented follow-up within 30 days and specific referrals to behavioral health services within 10 days.
Action Required
Immediately: Providers must implement maternal mental health screening protocols using Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9) during pregnancy (first trimester recommended) and postpartum (within 6 weeks and up to 1 year). Billing team must ensure proper coding using CPT 96127, HCPCS G0444, G8431, G8510, and ICD-10 Z13.31/Z13.32 for HEDIS compliance. Document all screening scores in medical records and establish referral workflows to Carelon Behavioral Health (877) 344-2858 for mild-moderate cases within 10 days and LA County Mental Health (800) 854-7771 for high-level needs. Positive screens require documented follow-up within 30 days or claims may be impacted.