TO: Maternity
Care Providers (MCPs)
RE: Coverage Update for 96127,
Extended to Pregnant and Postpartum Recipients over 21
Effective January
1, 2026, the Alabama Medicaid Agency will update coverage of procedure code 96127
to allow for prenatal and postpartum depression screening to pregnant
recipients over the age of 21.
- MCPs will be allowed to bill 96127
- Procedure code 96127 will be allowed once per date of service and
up to four submissions per perinatal period
- Claims will require a pregnancy or postpartum diagnosis and
diagnosis code Z13.30
- Claims will be paid outside of the maternity global payment
- The following screening tools are eligible for reimbursement under
this provision:
o Edinburgh Postnatal
Depression Scale (EPDS)
o
Hamilton Rating Scale for Depression (HAM-D)
o
Montgomery-Asberg Depression Rating Scale (MADRS)
o
Beck’s Depression Inventory (BDI)
o
Generalized Anxiety Disorder 7 (GAD-7)
o
Mood Disorder Questionnaire (MDQ)
o
Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)
o Duke
Anxiety-Depression Scale (DUKE-AD)
Providers with billing
questions may contact the Gainwell Technologies Provider Assistance Center
at
1-800-688-7989.
The Current
Procedural Terminology (CPT) and Current
Dental Terminology (CDT) codes descriptors, and other data are copyright
© 2025 American Medical Association and © 2025 American Dental Association (or such
other date publication of CPT and CDT). All rights reserved. Applicable
FARS/DFARS apply.