CPT 96127 Frequently Asked Questions
Updated January 4, 2023
What is the purpose of CPT 96127?
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.
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, and NP)
Do I have to be a behavioral health provider to 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 cannot bill for 96127 because the CPT codes used for their services already include any work to uncover or monitor mental health conditions.
Can therapists or social workers bill CPT 96127?
No. LPCs, LSWs, etc cannot bill 96127 because the CPT codes used for their services already include uncovering or monitoring mental health conditions.
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 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).
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?
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. (UPDATED 01/04/2023)
How much does CPT 96127 pay?
The amount varies per insurance company, but as of January 2023 the Medicare average is $4.61 per unit with a limit of 3 units per date of service.
Can CPT 96127 be billed with a Telemedicine visits?
As of January 2023 CMS has approved 96127 for use with telemedicine, including audio only, through December 31, 2023..
Which modifiers should I use when billing 96127?
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.
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. 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.
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.xx. Learn more about the fight to enforce mental health parity laws at the Kennedy Forum.