Provider Notice issued 11/06/07

Perinatal Depression Screening and Objective Developmental Screening

Effective with dates of service on or after July 1, 2007, HFS began reimbursing community mental health providers for perinatal depression screenings for women and objective developmental screenings for children.  These services are covered by HFS and are now billable only to HFS directly for HFS enrolled children and pregnant or post partum women.  The following codes will be opened for billing by community mental health providers:

Screening for Perinatal Depression (HCPCS code H1000 and CPT Code 99420 with modifier HD)

Community mental health providers may bill for perinatal depression screening to identify women who may be at risk of or experiencing perinatal depression.  Providers must follow the billing guidelines outlined in an Informational Notice titled “Screening for Perinatal Depression” dated November 30, 2004.  This notice is located on the department’s Web site at:

http://www.hfs.illinois.gov/physicians/2004.html

To assist providers that identify women who may need assistance regarding perinatal depression as a result of a screening, HFS has identified several perinatal depression resources on our Web site, listed below.  The University of Illinois at Chicago (UIC) operates a Perinatal Depression Consult Line at 1-800-573-6121.  The consult line has trained staff available, free of charge, as a resource to providers.  The UIC has developed training programs for providers working with individuals being screened for perinatal depression.  Providers who have questions about screening, assessment or treatment of perinatal depression can call the UIC Perinatal Mental Health Consult Service, to speak with a perinatal mental health expert.  At that same phone number, providers can also request basic or advanced training workshops, related to screening, assessment and treatment of perinatal depression.  For further information, please review the material located at:

http://www.psych.uic.edu/

http://www.hfs.illinois.gov/mch/

Those women who are screened for perinatal depression should be encouraged to receive regular prenatal care, if pregnant; post partum care, if during the post partum period, and family planning, if after the post partum period.

Objective developmental screening for children (CPT codes 96110 and 96111)

Community Mental Health providers may bill for the developmental screening which includes the administration, interpretation and reporting of an HFS approved objective developmental screening to identify children who may be developmentally delayed or at risk for developmental delays. By reimbursing community mental health providers who perform objective developmental screening, referrals to primary care providers and the early intervention system, as appropriate, will be facilitated.  This will provide optimal opportunity for needed intervention at the earliest point in time. To receive reimbursement for developmental screening, an HFS approved objective developmental screening tool must be used. It is important that the testing documentation be incorporated in the child’s clinical record along with a plan for further assessment and follow-up, including any needed treatment.  At a minimum, periodic objective developmental screening is recommended during the child’s 9th, 18th, and 24-30 months of life.  More frequent objective developmental screenings may be performed, based on the needs of the child, and reimbursement for objective developmental screening is available for children over 30 months of age. 

Billing instructions are located in the Healthy Kids Manual, Topic 202.1.  To ensure proper billing, please review the HFS’ Healthy Kids Manual, Chapter 200,Topic HK-203.53 for a complete list of developmental evaluation tools approved by the department.  The Healthy Kids Manual may be viewed or printed from HFS’ Web site at:

http://www.hfs.illinois.gov/handbooks/chapter200.html

and click on Healthy Kids Handbook. 

Children who are screened developmentally delayed or at risk for delay, should be referred to Early Intervention (EI) and their “medical home” (primary care provider).

Coordination and Referral to Early Intervention

The State Early Intervention Program (Part C of the Individuals with Disabilities Act) provides services to children who are under 36 months of age who have disabilities, developmental delays or are at risk of substantial delays.  Early Intervention will also accept infants of mothers diagnosed with maternal depression.  The Illinois Department of Human Services serves as the lead agency for this program.  All children under 36 months of age with disabilities, developmental delays or who are potentially at-risk for developmental delays should be referred to the Early Intervention Services System.  You may contact the Illinois Department of Human Services Help Line (also known as the Help Me Grow Help Line) at 1-800-323-4769 or the Bureau of Early Intervention at 217-782-1981 to locate the Child and Family Connections office closest to a family for referral purposes.  For additional information and referral, please review the Healthy Kids Manual, Topic HK-207.6 at the link listed above.

Coordination and Referral to Illinois Health Connect or a Managed Care Organization

In July 2006, the State of Illinois implemented a new program called Illinois Health Connect, which is a statewide Primary Care Case Management (PCCM) Program. Individuals may select a PCCM or Managed Care Organization.  Once enrolled in Illinois Health Connect or a Managed Care Organization, individuals will have a “medical home” through a primary care provider (i.e., a physician that serves as the center for coordinating an individual’s medical care).  Information about the Illinois Health Connect Program can be found at: 

http://www.hfs.illinois.gov/managedcare/

If you have any questions regarding this notice, please contact the Bureau of Comprehensive Health Services toll-free, at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs