CPT 96127 Frequently Asked Questions

by | Feb 17, 2020

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

What is the official definition of CPT 96127?

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

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. 

What ICD-10 code should I use when billing G0444?

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

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 2020, the Medicare average is $5.

Which modifiers should I use when billing 96127?

See our previous article about 96127 

Can I bill 96127 together with 96138, or 96130?

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

Should insurance companies be able to require medical records to pay claims for 96127?

No, but that is not stopping some from doing so. 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 Z13.89. Learn more about the fight to enforce mental health parity laws at the Kennedy Forum.

Should insurance companies be able to require prior-authorization to pay claims for 96127?

No, but that is not stopping some from doing so. 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 Z13.89. Learn more about the fight to enforce mental health parity laws at the Kennedy Forum.

 

Learn about more mental health billing codes: Request our Billing/ Coding Sheet