Mental health assessment for young children
Developmentally appropriate assessment is key to effective mental health care for children birth to age five. In 2021, the Washington State Legislature passes a law aligning Apple Health policies with best practices for assessing young children’s mental health.
This page supports providers, billers and partners with helpful information and tools.
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Overview
About 1 in 5 young children have a mental, behavioral, or developmental disorder. When caught early, these conditions can be treated effectively. Accurate assessment is the first step for effective treatment.
Washington’s infant-early childhood mental health (IECMH) community worked together for several years to champion policy change. In 2021, state law (RCW 74.09.520(11)) and WAC 182-531-1400(9)(a)(ii) were updated to:
- Allow reimbursement for multi-session assessments
- Allow reimbursement for provider travel to home or community settings
- Require use of the DC:0-5™ diagnostic manual
These changes began in January 2022. A follow-up survey in Fall 2022 found positive impacts for providers, families, and children.
How to bill
HCA offers guidance and support to help providers bill correctly for mental health assessments for young children.
Webinars and office hours
For multisession assessments
Providers can bill for up to five sessions per child per calendar year, without prior authorization. Use standard Psychiatric Diagnostic Evaluation CPT®/HCPCS codes for each session.
View:
For provider travel
Travel is reimbursable when assessments happen in the home or community.
Requirements:
- CPT®/HCPCS Code (90791, 90792, H0031)
- Child must be under age 6
- Place of Service Code: 03: (School), 04 (Shelter), 12 (Home), 99: (Other)
Mileage rates are set by the Office of Financial Management.
Claims not eligible for reimbursement
Claims with a U8 modifier, services provided to Wraparound Intensive Services (WISe) participants, are NOT eligible for MHAYC provider travel reimbursement
Travel reimbursement by coverage type
Managed care
Follow the managed care organization's (MCO) policies.
Without a managed care plan (or fee-for-service)
Questions? Contact HCA’s FFS team
Using the DC:0-5
The DC:0-5™ is a best-practice diagnostic manual for infants and young children. It is required for Apple Health assessments for children through age 5 (RCW 74.09.520). The DC:0-5™ uses criteria specific to early childhood and it is recommended by CMS and SAMHSA.
Required use
Although the 2021 legislation didn’t set an implementation date, HCA interprets the law (House Bill 1325) to mean that all providers should be working towards using the DC:0-5™. HCA is focused on supporting providers through training and resources.
Apple Health DC:0-5™ Crosswalk
The Apple Health DC:0-5 crosswalk connects DC:0-5 diagnoses with ICD-10 codes. Washington created a DC:0-5 Crosswalk to meet billing requirements, because federal rules require ICD-10 codes on all claims, even when the DC:0-5 is used for diagnosis.
The DC:0-5 manual includes its own crosswalk, but it’s not updated regularly or aligned with Apple Health. That’s why HCA publishes its own version.
DC:0-5™ training
Many providers don’t learn about the DC:0-5 in school. Washington offers free DC:0-5 training for Apple Health providers.
Provided by the IECMH Workforce Collaborative (IECMH-WC):
- For mental health providers: Clinical training, communities of practice, workshops
- For allied professionals: DC:0-5 overview training
Find free training opportunities.
Questions? Contact the IECMH-WC team.
DC:0-5™ in clinical records
As of May 1, 2023, Washington Department of Health (DOH) allows licensed behavioral health agencies to use either DSM-5 or DC:0-5 for diagnostic assessments (WAC 246-341-0640). This aligns with HCA’s Apple Health guidance.
HCA plans to offer more tools to help providers align documentation practices with early childhood standards. Interested in helping? Contact Christine Cole.
Other resources
Doing mental health assessments for young children may be new for some providers. HCA provides additional resources to support best practices within the field.
MHAYC Provider Spotlight series
Learn how other providers are doing this work. Each spotlight focuses on a different part of implementation. Watch recordings or register for upcoming events.
Visit the IECMH office hours page.
MHAYC multidisciplinary referral guide
A strong assessment includes input from across a child’s life-caregivers, educators, and others, and sometimes, an assessment may indicate children have needs that a mental health provider cannot address. This guide helps providers connect families to non-mental health services when needed.
Stay connected
Want the latest news and updates?
- Subscribe to the Prenatal-25 behavioral health mailing list for announcements, trainings, and policy updates
- Check out the latest bulletins and resources under IECMH updates on the IECMH webpage.
(Updated May 2025)