October marks National Depression and Mental Health Screening Month, and the Policy Center has been tracking new screening developments that will impact providers and patients. 

These highlights include:

  • Monitoring screening rates, potential changes to the perinatal depression HEDIS measures
  • The release of the EPDS-US
  • Unbundling of maternity care payments to OB/Gyns (and likely midwives)

Research estimates less than 20% of women are screened1, and 50-70% go undiagnosed.2 Meanwhile, stress, anxiety, and depression during pregnancy are linked to both poor maternal and infant  health outcomes.3 Screening offers a first step as an important tool to help identify those at risk of maternal mental health disorders.4

Because many women enter pregnancy with untreated anxiety or depression, or experience these disorders for the first time during pregnancy, the Policy Center recognizes obstetricians as the primary providers who should routinely and universally screen for maternal mental health disorders beginning in pregnancy and throughout the 12 months postpartum. 

Despite the long-standing recommendation to screen using research-validated screening tools by the U.S. Preventive Services Task Force, American College of Obstetrics and Gynecology (ACOG), and others, screening has not been universally implemented. 

In 2023, ACOG issued the first-ever U.S. Clinical Practice Guideline on the screening and diagnosis of mental health conditions during pregnancy and postpartum, which further solidified the need to screen beginning in pregnancy (and throughout 12 months postpartum), recognizing the need to provide interventions and treatment in pregnancy, reducing the incidence of prenatal and postpartum depression and preterm birth.5

As noted above, there have been recent developments in screening, which we wish to highlight for the field: 

  1. The release of the EPDS-US: 

Many users of the Edinburgh postpartum depression screener (EPDS) have raised concerns about the non-concordance of the screener questions to U.S. culture and language. To combat these challenges, researchers at the Virginia Commonwealth University created a U.S. version of the EPDS, the EPDS-US, a promising new tool for more effectively detecting maternal depression and anxiety in Americans. The Policy Center will be tracking the further validation of this tool and providing updates to the field through our newsletter.  

  1.  The AMA’s unbundling of maternity care 

On October 3, 2025, the American Medical Association (AMA) approved deleting the global obstetric billing codes. This means that the flat payment for maternity care through 6 weeks postpartum, often paid by insurers to contracted OB/Gyns and midwives, will no longer be billable as of January 1, 2027.  ACOG released the following statement to its members: 

“ACOG has long advocated for the replacement of the global obstetrics code with a system that better reflects the reality of how obstetric care is provided in the United States. Ob-gyns should stay tuned for information, resources, and in-person events from ACOG throughout 2026 about how they can effectively use the updated codes to ensure that they are getting reimbursed more fairly and equitably for the care that they provide patients. For questions, please reach out to ACOG’s Payment Advocacy & Policy Portal.”  

  1. Monitoring screening rates, potential changes to the perinatal depression HEDIS measures

The Policy Center and philanthropic funders championed the development of measures to monitor the frequency of screening during pregnancy and postpartum. Monitoring of care provided to Americans outside of hospitals has generally occurred through HEDIS measures, developed by the National Committee for Quality Assurance (NCQA).  Though the perinatal mental health HEDIS screening rates were first reported by NCQA in 2019, the data have been unreliable for a number of reasons, including the fact that NCQA requires the use of LOINC codes rather than claim codes for these and other relatively new measures.  The Policy Center has been advocating for the use of claim codes (with a modifier to identify positive vs. negative screens) in place of LOINC codes.  (Stay tuned for our latest report of state-level HEDIS perinatal depression and follow-up measure results, which will be released in November 2025).  

Learn more about screening and research-validated screening tools by visiting our Maternal Mental Health Screening Resource Hub.

Additional Resources from the Policy Center 

References
  1. The Policy Center for Maternal Mental Health (2022, November). U.S. Maternal Depression Screening Rates Released for the First Time Through HEDIS. Policy Center for Maternal Mental Health. https://policycentermmh.org/u-s-maternal-depression-screening-rates-released-for-the-first-time-through-hedis/ ↩︎
  2. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2021. Natl Vital Stat Rep. 2023 Jan;72(1):1-53.  ↩︎
  3. Alliance on Innovation for Maternal Health. (2023). Perinatal Mental Health Conditions. https://saferbirth.org/wp-content/uploads/R1_AIM_Bundle_PMHC.pdf ↩︎
  4. Bauman, B. L. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 69. https://doi.org/10.15585/mmwr.mm6919a2 ↩︎
  5. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4: (2023). Obstetrics & Gynecology, 141(6), 1232. https://doi.org/10.1097/AOG.0000000000005200 ↩︎