Aetna Better Health of Florida Prenatal and Postpartum Depression Screening Coding Guide for HEDIS

Aetna Better Health® of Florida has shared updated, agency-adapted guidance for two HEDIS® MY 2026 measures: Prenatal Depression Screening and Follow-Up (PND-E) and Postpartum Depression Screening and Follow-Up (PDS-E). The guidance focuses on four things providers need to get right. Screening should be done with a standardized instrument, coding on the claim should be complete, and the screening result should be documented. When a screen comes back positive, qualifying follow-up must be completed within 30 days of the first positive screen. 

Aetna Better Health of Florida Depression Screening Codes for HEDIS MY 2026

Providers screening for prenatal and postpartum depression should apply the HEDIS specifications for both PND-E and PDS-E, along with Aetna Better Health of Florida’s agency adaptation. Under this adaptation, the plan may accept a few extra codes for Numerator 1, Depression Screening, in addition to the codes already listed in the HEDIS specifications.

Additional CPT and ICD-10-CM Codes for Depression Screening

The plan may contain additional CPTs that are: 

• CPT 96160: Patient-focused health risk assessment
• CPT 96161: Caregiver-focused standardized screening administered during a maternal or well-child visit
• CPT 96127: Brief emotional or behavioral assessment

The plan may also include these ICD-10-CM codes:

• Z13.31: Encounter for screening for depression
• Z13.32: Encounter for screening for maternal depression

Prenatal and Postpartum Depression Screening Steps

To meet the PND-E and PDS-E measures, providers should follow these steps for every eligible member:

• Screen eligible pregnant and postpartum members using an age-appropriate standardized instrument.
• Record the screening date, the instrument used, the numeric score, and the positive or negative interpretation.
• For a positive result, arrange and document qualifying follow-up on the day of the first positive screen or up to 30 days after it.
• Submit the appropriate screening, follow-up, and diagnosis codes on the claim or encounter, as applicable.

Aetna Better Health of Florida 30-Day Follow-Up Codes After a Positive Depression Screen

Each follow-up activity below has its own code type, commonly used codes, and coding guidance for use within 30 days of the first positive screen.

Follow-Up Office Visit

• Code type: CPT codes from the catagory of behavioral health diagnosis
• Commonly used codes: 99202 to 99205, 99211 to 99215
• Important coding guidance: Must be billed with a diagnosis of depression or another qualifying behavioral health condition, such as F32.x, F33.x, F41.x, F43.2x, F53.0, or O99.34x.

Telehealth Follow-Up Visit

• Code type: CPT + behavioral health diagnosis
• Commonly used codes: 98000 to 98016
• Important coding guidance: This code should be used to bill with a diagnosis of depression or any other qualifying behavioral health diagnosis, such as F32.x, F33.x, F41.x, F43.2x, F53.0, or O99.34x.

Behavioral Health Encounter

• Code type: CPT
• Commonly used codes: 90791, 90792, 90832 to 90834, 90836 to 90839
• Important coding guidance: Qualifies as follow-up care after a positive depression screen.

Depression Case Management Encounter

• Code type: CPT
• Commonly used codes: 99366, 99492, 99493
• Important coding guidance: Will qualify if depression symptoms OR a behavioral health diagnosis is documented. 

Antidepressant Medication

• Code type: Pharmacy claim
• Commonly used codes: Antidepressant medication dispensed
• Important coding guidance: A dispensed antidepressant medication counts toward follow-up compliance.

Why a Follow-Up Visit Code Alone Won’t Meet the Measure With Aetna Better Health of Florida

Billing a follow-up visit code on its own does not satisfy the PND-E or PDS-E measure. For an office or telehealth follow-up visit to count, the claim also needs a qualifying diagnosis of depression or another behavioral health condition. That diagnosis is what shows the visit was follow-up care after the positive screen, rather than a routine visit.

The qualifying diagnosis can include postpartum depression, depression, anxiety, or adjustment disorder, as long as the medical record supports it.

What If a Member Screens Positive for Postpartum Depression?

This is one of the most common situations providers will see. When a member has a positive postpartum depression screen, the follow-up visit can be billed as 99213 with F53.0, as long as it takes place within 30 days of the positive screen. Here, 99213 reports the follow-up office visit, and F53.0 provides the qualifying diagnosis that ties the visit back to the positive screen.

Aetna Better Health of Florida Depression Screening Documentation Checklist

Providers should record the following information for each depression screening they provide the member: 

• Date of screening
• Screening instrument used, such as EPDS, PHQ-9, or PHQ-2
• Numeric score or result
• Positive or negative interpretation
• Follow-up plan, if the result is positive
• Follow-up visit date and service code, if completed within 30 days of the first positive screen
• Behavioral health diagnosis, assessment, therapy, medication management, or case management documentation, when applicable

Reviewing Screening and Follow-Up Workflows for HEDIS MY 2026

Aetna Better Health of Florida wants to inspect providers' clinical, documentation, and billing work processes. The aim is to ensure that all potential members are screened and that any positive result is followed up, completed and recorded within 30 days. Providers should claim according to current HEDIS specifications and agency guidance when claiming claims or encounter data.

What If a Member Screens Positive?

A positive screen calls for more than scheduling a follow-up. Providers should first assess the member for immediate safety concerns, then document the screening score or results along with the follow-up plan. From there, the member should be referred to appropriate behavioral health services and/or Progeny Health Maternity Care Management for additional case coordination support.

What This Means for Your Practice

• Report depression screening with CPT 96160 / 96161 / 96127 and ICD-10-CM Z13.31 or Z13.32, including the date of the screen, instrument used, numeric screen score and positive or negative interpretation of the screen. 
• Complete qualifying follow-up within 30 days of the first positive screen using 99202 to 99205, 99211 to 99215, 98000 to 98016, 90791, 90792, 90832 to 90834, 90836 to 90839, 99366, 99492, or 99493.
• Pair every office or telehealth follow-up visit with a qualifying behavioral health diagnosis such as F53.0, F32.x, F33.x, F41.x, F43.2x, or O99.34x, and never bill the visit code alone.
• Assess for immediate safety concerns on every positive screen, and refer the member to behavioral health services and/or Progeny Health Maternity Care Management.

A screening only counts when the codes, the documentation, and the 30-day follow-up all line up on the claim.

Support Prenatal and Postpartum Depression Screening Billing With BillingFreedom

A follow-up visit may be conducted without a qualifying diagnosis or outside of the 30-day window and not trigger the PND-E or PDS-E measure even if a completed depression screening was previously conducted. BillingFreedom helps Florida practices close those gaps on Aetna Better Health claims. Our OB/GYN medical billing services team checks that screening codes like 96127 and Z13.32 are reported correctly, matches each follow-up visit with the right behavioral health diagnosis, and tracks the 30-day timeline from the first positive screen so qualifying follow-up is captured on the claim or encounter. Reach us at info@billingfreedom.com or +1 (855) 415-3472. All the screenings and all the follow-ups were captured!

Source: Aetna Better Health® of Florida, Provider Bulletin: Agency-Adapted Prenatal and Postpartum Depression Screening and Follow-Up (8457551-43-01)