Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services.
What is the official definition of CPT 96127?
Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument.
When can I bill for CPT 96127?
CPT 96127 can be billed on the same date of service as other common services such as psychiatry or therapy appointments and is appropriate when used as part of a standard clinical intake. Primary care and other specialists may use CPT code 96127 when screening and assessing their patients, up to four times per year per patient.
What mental health conditions does it cover?
It should be used to report a brief assessment for ADHD, depression, suicidal risk, anxiety, somatic symptom disorder and substance abuse and can be billed up to 4 times per year, with a maximum of 4 different screens per visit, but this may vary based on insurance provider.
Who can bill CPT Code 96127?
Any qualified healthcare professional; MD, DO, PA, NP, LPC, LSW, etc.
Do I have to be a behavioral health provider to bill 96127?
No. There is a clear connection between physical medicine, and mental health. 96127 was created to generically, and evenly screen for mental health in a broad population of patients across many disciplines.
What is the difference between CPT 96127 and G0444?
96127 is for use with major medical, or Medicare visits other than the annual wellness visit. G0444 is for use in the Medicare annual wellness visit only.
What ICD-10 code should I use when billing 96127?
Most insurances require the generic ICD-10 code Z13.89.
How many times per year can I bill CPT 96127?
The generally accepted answer is that you can bill CPT code 96127 up to 4 times per year, up to 4 units per visit. However, each insurance differs as to the number of times per year, or units per visit. Medicare does not publish limits for billing 96127, but only allows G0444 (see above) one time per year with no additional units.
How much does CPT 96127 pay?
The amount varies per insurance company, but as of January 2021, the Medicare average is $5.
Can I bill CPT 96127 with Telemedicine?
As of January 2021 CMS has permanently approved 96127 for use with telemedicine.
Correct coding and documentation
Four codes are used to report structured screening and
assessments:
| CPT Code | Purpose | Examples (not all inclusive) | Notes |
| 96110 | Childhood instrument based screening for failure to develop and/or achieve skills according to the expected time frame (e.g., expressive and receptive language, motor skills) |
|
Use for developmental and autism screening. |
| 96127 | Instrument-based assessment of potential emotional and/or behavioral problems (e.g., depression, attention-deficit) |
|
Use for both screening and follow-up of emotional and behavioral health conditions. Report HCPCS code G0444 for depression screening in lieu of code 96127 for Medicare Part B patients. |
| 96160 | Instrument-based assessment of the patient’s risk for certain health conditions, behaviors that may negatively impact health, and pros and cons for initiating behavior change |
|
Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. If brief intervention for alcohol or substance abuse (at least 15 minutes) is also provided, report codes 99408 – 99409 based on time. |
| 96161 | Instrument-based assessment of the caregiver’s risk for certain health conditions that may impact his or her ability to care for the patient |
|
Report code 96161 for a health risk assessment when focused on caregiver risk that may impact the patient’s health (e.g., postpartum depression) |
Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). However, code 96127 should be reported for both screening and follow-up of emotional and behavioral health conditions.
Emotional and behavioral health assessments
Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. For instance, Aetna has a long-standing policy to cover depression screening in primary care when the service is performed using the Patient Health Questionnaire-9 (PHQ-9) tool and is reported with code 96127.
Code 96127 is also applicable to assessments for conditions such as anxiety, attention-deficit disorders, and generalized psycho-social symptoms(e.g., pediatric symptom checklist). Report ICD-10 code Z13.89, “Encounter for screening for other disorder,” in conjunction with depression screening services. Use of structured instruments for assessing attention deficit should be linked to the ICD-10 code for the diagnosis or symptoms that prompted the assessment.
Health risk assessment
Medicaid plans often allow payment for adolescent HRAs using tools such as the HEEADSSS (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety) assessment or the CRAFFT (Care, Relax, Alone, Forget, Friends, Trouble) screening tool. For example, Texas Health Steps pays for adolescent mental health screening using specified structured instruments reported with code 96160 when completed by the patient, and 96161 when completed by a caregiver.