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Covered and Noncovered Services : Mental Health and Substance Abuse Screening for Pregnant Women

Topic #4446

Coverage Limitations

Mental Health and Substance Abuse Screening

The screening (HCPCS procedure code H0002 with modifier "HE" or "HF") is limited to one unit of service per member per pregnancy. A unit of service is equivalent to the total amount of time required to administer the screening. Providers are encouraged to use more than one screening tool during the screening process when appropriate.

The screening is not considered part of the mental health and substance abuse services available under BadgerCare Plus or Wisconsin Medicaid. The screening does not require PA and is not counted towards any service limitations or PA thresholds for those services.

Preventive Mental Health Counseling and Substance Abuse Intervention

The counseling/intervention services (HCPCS procedure code H0004 with modifier "HE" or "HF") are limited to four hours (or 16 units of service, each unit equivalent to 15 minutes) per member per pregnancy. If a member receives both preventive mental health counseling and substance abuse intervention services, the hours of both services count toward the four-hour limit. Additionally, only one hour (up to four units of service) can be billed on one DOS. The counseling and intervention services must be provided on the same DOS or on a later DOS than the screening.

These services are covered during the pregnancy and up to 60 days postpartum.

These services are not considered part of the mental health and substance abuse services available under BadgerCare Plus or Wisconsin Medicaid and are not counted towards any service limitations or PA thresholds for those services.



 
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