CPT 96127 Frequently Asked Questions

CPT Code 96127 is a generic mental health screening code that is covered by most major insurances. It is designed to pay for the evenly applied screening of a large patient population to uncover underlying mental health conditions.

Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument.

A physician or other qualified healthcare professional may bill 96127. For example a Family Practice MD, an Internal Medicine PA, or a Pediatric NP. A behavioral health specialty is not required. Therapists and Non- Clinical Social Workers cannot bill 96127.

No. 96127 was created for use in physical medicine clinics, such as primary care, to screen for underlying mental health conditions. Typically behavioral health providers should not bill for 96127 because the CPT codes used for their services already include any work to uncover or monitor mental health conditions.

No. LPCs, LSWs, etc cannot bill 96127 because the CPT codes used for their services already include uncovering or monitoring mental health conditions.

96127 is for use with major medical, or Medicare visits other than the annual wellness visit. The code covers any mental health condition screened (ie depression, anxiety, etc). G0444 is for use in the Medicare annual wellness visit only and is for annual depression screening only. Typically G0444 pays 3 times more than 96127.

Most insurance companies accept the generic visit ICD-10 code Z13.xx (ie. Z13.31, Z13.39, Z13.89) if results are negative, and either Z13.xx or codes beginning in F if the results are positive.

Medicare requires that you use the same ICD-10 code as you use for the annual wellness visit.

CMS does not limit the number of times CPT code 96127 may be billed per year. There is an MUE limit of 3 units per date of service. Although major insurances typically follow CMS guidelines, they may impose their own limits on the number of times per year that 96127 may be billed. Make sure to check the guidelines for each insurance you intend to bill.

The amount varies per insurance company, but as of January 2024 the Medicare average is $4.57 per unit with a limit of 3 units per date of service.

As of January 2024 CMS has approved 96127 for use with telemedicine, including audio only, through December 31, 2024.

When 96127 is billed with an E&M code, the E&M code should be billed first with a modifier 25. 96127 should be billed last with a modifier 59. For more detailed information download our latest billing guide.

No. Most insurances, including Medicare will not pay for both 96127 and 96138, and/ or 96130. Read more about 96138 and 96130.

No, but that is not stopping some from doing so. CPT 96127 is meant as a generic screening code that is evenly applied against a large patient population to uncover underlying mental health conditions. Most insurances require the use of the generic screening code Z13.xx. Learn more about the fight to enforce mental health parity laws at The Kennedy Forum.

No, but that is not stopping some from doing so. CPT 96127 is meant as a generic screening code that is evenly applied against a large patient population to uncover underlying mental health conditions. Most insurances require the use of the generic screening code Z13.xx. Learn more about the fight to enforce mental health parity laws at The Kennedy Forum.