Obstetric Provider Billing Rates by Private Insurers for Maternal Mental Health Screening and Treatment

Background

As the primary provider during the perinatal period, obstetric providers (OBs), including OB-GYNs, midwives, and family practice providers who deliver babies, play a key role in providing screening and treatment for maternal mental health (MMH) disorders. Guidelines recommend that OBs routinely screen for MMH disorders and provide appropriate follow-up treatment.^1,2,3 Yet, research suggests that less than 20% of mothers receive screening, only 20% receive adequate treatment, and roughly 20% of maternal deaths result from suicide. ^. One key lever for improving these rates is through payment strategies.^4,5,6

Payment for Obstetric MMH Screening and Treatment

Currently, most private insurers reimburse OBs through a “bundled obstetric payment” for maternity services.⁷ The “bundled obstetric payment” is currently billed using Current Procedural Terminology (CPT®) codes managed by the American Medical Association (AMA). However, expert bodies such as the American College of Obstetrics and Gynecology (ACOG) have suggested that this bundled payment may disincentivize OB providers from providing MMH screening, and instead, fee-for-service (FFS) payments with pay-for-performance incentives may lead to improved outcomes as well as lower-cost care.^8,9,10 Little is known about the rates at which OBs bill insurers separately for MMH screening and treatment, specifically among the 52% of mothers covered by private insurance.¹¹ This study seeks to understand the extent to which OB providers submit separate claims for MMH screening and follow-up treatment to private insurers, outside of the “bundled obstetric payment.”

Methods

For this study, the Policy Center for MMH analyzed a dataset created by FAIR Health® from its FAIR Health National Private Insurance Claims (NPIC)® database.  The NPIC is the largest repository of private insurance claims data in the United States, aggregating data from the country’s largest insurers.¹² Representing over 52 billion claims since 2002, the NPIC represents a large portion of the privately-insured US population.¹³

The FAIR Health dataset includes de-identified, aggregated private insurance claims submitted by enrollees’ providers in 2021-2024 for any of 28 “screening” codes and 62 “evaluation and management” codes. (See Appendix 1 for all “screening” and “evaluation and management” claims codes included in the dataset, and Appendix 2 for all provider types included.)  

The study team conducted a descriptive, quantitative analysis of the data. This analysis included:

1. Identifying the rates of screening claim submissions by perinatal phase (prenatal or postpartum). Claim rates were also analyzed among provider types included in this data set (see Appendix 2), including obstetric providers (OB-GYNs, certified nurse midwives, and family practice providers).
2. Identifying the rates of “evaluation and management” claim submissions for perinatal patients with a mental health diagnosis code. These rates were also identified by perinatal phase (prenatal or postpartum), and among provider types.  
3. Identifying rates of mental health treatment claims for psychotherapy and mental health facility services by perinatal phase (prenatal or postpartum).

Importantly, this claim data demonstrated the frequency with which obstetric providers billed private insurers for screening and “evaluation and management” services, not the frequency with which screening and “evaluation and management” services occurred. 

Limitations

The FAIR Health dataset does not include medication claims data. Therefore, this analysis does not include rates at which medications are prescribed to treat MMH disorders.

Findings: MMH Screening Claims

Tables 1 and 2 show the rates at which privately-insured perinatal patients’ providers submitted a mental health screening claim. Table 1 shares these rates among all providers included in this study (see Appendix 2), and Table 2 shares these rates specifically among OB providers, including OB-GYNs, family practice providers, and certified nurse midwives.

Table 1: % of Privately-Covered Perinatal Persons Whose Provider Submitted a MMH Screening Claim

Provider Type	Perinatal Phase	2021	2022	2023	2024
All providers	Prenatal	0.5%	0.6%	0.8%	1.1%
	Postpartum	0.8%	1.0%	1.2%	1.4%

As seen in Table 1, approximately 1% of privately-insured prenatal and postpartum patients in 2021-2024 had a provider who submitted an MMH screening claim for reimbursement. These rates slightly increased over time. The percent of prenatal patients with a MMH screening claim increased from 0.5% in 2021 to 1.1% in 2024, and the percent of postpartum patients with a MMH screening claim increased from 0.8% in 2021 to 1.4% in 2024. In both cases, the rates at which MMH screening claims were submitted were extremely low.

Table 2: % of Privately-Covered Perinatal Persons Whose OB Provider Submitted a MMH Screening Claim

Provider Type	Perinatal Phase	2021	2022	2023	2024
OB-GYNs	Prenatal	0.1%	0.1%	0.1%	0.2%
	Postpartum	0.4%	0.5%	0.5%	0.6%
Family practice providers	Prenatal	0.2%	0.2%	0.3%	0.4%
	Postpartum	0.2%	0.2%	0.2%	0.3%
Certified nurse midwives	Prenatal	0.01%	0.02%	0.03%	0.04%
	Postpartum	0.04%	0.05%	0.07%	0.09%

Table 2 shows the role of OB providers in MMH screening claim submission. Among the approximately 1% of perinatal persons whose providers submitted a MMH screening claim, OB-GYNs and family practice providers are the most likely to submit these claims.  In 2024, 0.2% of perinatal patients’ OB-GYNs submitted a MMH screening claim prenatally, and 0.6% submitted a claim postpartum. Also in 2024, 0.4% of perinatal patients’ family practice providers submitted a MMH screening claim prenatally, and 0.3% submitted a claim postpartum. Certified nurse midwives (CNMs) were less likely to submit these claims. In 2024, 0.04% of perinatal patients’ CNMs submitted a claim prenatally, and 0.09% submitted a claim postpartum. These rates slightly increased over time, but submission rates overall remained very low.

Findings: MMH Evaluation and Management

When a patient screens positive for a MMH disorder, then providers conduct “evaluation and management services”, including developing a follow-up treatment plan with the patient. Tables 3 and 4 show the percentage of perinatal patients with a mental health diagnosis code who received “evaluation and management” (E&M) services. Table 3 shares these rates among all providers included in this study (see Appendix 2), and Table 4 shares these rates specifically among OB providers, including OB-GYNs, family practice providers, and certified nurse midwives.

Table 3: % of Privately-Covered Perinatal Persons Whose Provider Submitted a Claim for Mental Health Evaluation and Management

Provider Type	Perinatal Phase	2021	2022	2023	2024
All providers	Prenatal	7.0%	8.6%	9.5%	9.8%
	Postpartum	7.8%	7.5%	8.2%	8.5%

As seen in Table 3, approximately 10% of prenatal persons and 9% of postpartum persons in 2024 with a mental health diagnosis had a provider who submitted a claim for E&M services. An increasing number of perinatal patients have providers who submit claims for these services. The percentage of prenatal patients with a mental health diagnosis and E&M claim increased from 7.0% in 2021 to 9.8% in 2024. The percentage of postpartum patients with a mental health diagnosis and E&M claim increased from 7.8% in 2021 to 8.5% in 2024. 

Table 4: % of Privately-Covered Perinatal Patients Whose OB Provider Submitted a Claim for Mental Health Evaluation and Management

Provider Type	Perinatal Phase	2021	2022	2023	2024
OB-GYNs	Prenatal	1.6%	1.8%	2.0%	2.1%
	Postpartum	2.0%	2.1%	2.3%	2.3%
Family practice providers	Prenatal	2.4%	2.5%	2.7%	2.6%
	Postpartum	1.7%	1.7%	1.8%	1.8%
Certified nurse midwives	Prenatal	0.2%	0.2%	0.2%	0.3%
	Postpartum	0.2%	0.2%	0.3%	0.3%

Table 4 depicts the role of OB providers in submitting a claim for “evaluation and management” services among their patients with a mental health diagnosis. OB-GYNs and family practice providers are the most likely to submit these claims. In 2024, 2.1% of prenatal persons with a mental health diagnosis had an OB-GYN submit an E&M claim, and 2.3% of postpartum persons with a mental health diagnosis had their OB-GYNs do the same. Also in 2024, 2.6% of prenatal persons with a mental health diagnosis had a family practice provider submit an E&M claim, and 1.8% of postpartum persons with a mental health diagnosis had their family practice provider do the same. CNMs were less likely to submit these claims: in 2024, 0.3% of perinatal persons’ CNMs submitted a claim prenatally, and 0.3% submitted a claim postpartum. These rates slightly increased over time, but submission rates overall remained very low.

Findings: MMH Psychotherapy and Mental Health Facility Services

Table 5 shows the percent of perinatal persons who received mental health treatment, in the form of psychotherapy or mental health facility services. 

Table 5: % of Privately-Covered Prenatal and Postpartum Persons Whose Provider Submitted a Claim for Psychotherapy or Mental Health Facility Services, 2021-2024

Treatment Type	Perinatal Phase	2021	2022	2023	2024
Psychotherapy	Prenatal	3.1%	4.2%	4.7%	5.0%
	Postpartum	3.8%	3.5%	4.0%	4.3%
Mental Health Facility Services	Prenatal	0.04%	0.05%	0.06%	0.06%
	Postpartum	0.03%	0.03%	0.03%	0.04%

Table 5 illustrates that as of 2024, 4-5% of prenatal and postpartum patients had a claim submitted for psychotherapy. Also in 2024, less than 0.1% of perinatal patients had a claim submitted for mental health facility services (inpatient or outpatient).

Policy Recommendations

Given the current reliance on the “bundled obstetric payment,” it is not surprising that billing rates for MMH screening and “evaluation and management” are incredibly low by obstetric providers.

In response to concerns with the “bundled obstetric payment”, the AMA entered deliberations in 2025 to retire the maternity bundle codes. As of September 2025, AMA confirmed that it will retire maternity bundle CPT codes as of January 1, 2027.¹⁴  The aim is to replace the current codes with a new structure that supports accurate and comprehensive reporting of modern maternity services.

These AMA changes will directly impact the ways in which providers bill for MMH screening and treatment. In anticipation of this change, the Policy Center suggests two key policy recommendations: 

1. Payors need to provide detailed billing guidance to OBs for MMH screening and treatment. Payors can create bulletins that clarify the specific codes that OBs can bill to receive reimbursement for MMH screening, as well as “evaluation and management” following a positive screen.
2. Payors can refer to the Policy Center for Maternal Mental Health’s billing codes in their billing guidance. The billing codes recommended by the Policy Center include the latest resources from clinical bodies and the National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set (HEDIS) measures for perinatal depression. Additionally, the Policy Center includes behavioral health integration (BHI) codes and collaborative care codes (CoCM), which align with broader trends to support integrated mental health care.

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APPENDIX 1: FAIR Health CPT Codes Assessed

Service Category	Procedure Codes
Mental health screening	96127, 96136, 96137, 96138, 96139, 96146, 96150, 96151, 96156, 96160, 96161, 1220F, 2014F, 3351F, 3352F, 3353F, 3354F, 3700F, 3725F, G0444, G2121, G8431, G8510, G8511, H0002, H0031, S3005, 96127
General behavioral health integration (BHI)15	99484: BHI care management, with at least 20 minutes of allocated provider time per patient per calendar month
Behavioral health collaborative care model (CoCM)16	99492: First 70 minutes in the initial month of CoCM
CoCM17	99493: Each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified health care professional
CoCM18	99494: Each additional 30 minutes in any month, billed in conjunction with 99492 or 99493

APPENDIX 2: Provider Types in FAIR Health Dataset

Speciality Code	Speciality Description
110	Certified Nurse Midwife
120	Emergency Medicine
122	Family Practice
127	Infertility
130	Hospital
133	Internal Medicine
141	Neonatal-Perinatal Medicine
145	Nurse Practitioner
146	Obstetrics and Gynecology
179	Physician Assistant
186	Public Health or Welfare Agency
191	Single or Multispecialty Clinic or Group Practice
215	Registered Nurse
216	Licensed Practical Nurse

Acknowledgements

Access to the FAIR Health data set was made possible through a grant to the Policy Center for Maternal Mental Health from the ZOMA Foundation. 

Disclaimers

Research for this article is based upon healthcare claims data compiled and maintained by FAIR Health, Inc.  Authors are solely responsible for the research and conclusions reflected in this article.  FAIR Health, Inc. is not responsible for the conduct of the research or for any of the opinions expressed in this article. The source for certain health plan measure rates and benchmark (averages and percentiles) data (“the Data”) is Quality Compass® 2023 and is used with the permission of the National Committee for Quality Assurance (“NCQA”). Any analysis, interpretation or conclusion based on the Data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion. Quality Compass is a registered trademark of NCQA. The Data comprises audited performance rates and associated benchmarks for Healthcare Effectiveness Data and Information Set measures (“HEDIS®”) and HEDIS CAHPS® survey measure results. HEDIS measures and specifications were developed by and are owned by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties or endorsement about the quality of any organization or clinician that uses or reports performance measures or any data or rates calculated using HEDIS measures and specifications, and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in Quality Compass and the Data, or NCQA has obtained the necessary rights in the Data, and can rescind or alter the Data at any time. The Data may not be modified by anyone other than NCQA. Anyone desiring to use or reproduce the Data without modification for an internal, noncommercial purpose may do so without obtaining approval from NCQA. All other uses, including commercial use and/or external reproduction, distribution or publication, must be approved by NCQA and are subject to a license at the discretion of NCQA. © 2023 National Committee for Quality Assurance, all rights reserved. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

References