CPT 96127: Billing Guide & FAQ (2026)
CPT 96127 is the billing code for brief emotional and behavioral assessment with scoring and documentation, per standardized instrument. As of January 2026, the Medicare national average reimbursement is $4.97 per unit with a maximum of 3 units per date of service. This code is the primary way primary care providers get reimbursed for routine mental health screening.
Understanding how to bill 96127 correctly is critical for practices that screen patients for depression, anxiety, ADHD, substance use, and other mental health conditions. Below is a comprehensive guide covering eligibility, reimbursement rates, modifier rules, ICD-10 pairing, and the most common billing questions providers ask.
What is CPT 96127?
96127 is defined as: “Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument.”
This code reimburses providers for administering and scoring validated screening instruments as part of a patient visit. Each unit of 96127 represents one standardized instrument administered and scored. With Connected Mind, a single screening session covers six conditions simultaneously — depression, anxiety, ADHD, bipolar disorder, substance use disorder, and somatic symptom disorder — allowing providers to bill up to 3 units per visit.
Who Can Bill 96127?
Any physician or qualified healthcare professional may bill 96127. This includes providers holding credentials such as MD, DO, PA, NP, DNP, PhD, or PsyD. CMS defines a qualified healthcare professional as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice — there is no specialty restriction. Individual payer credentialing requirements may vary.
Who generally cannot bill 96127: Licensed Professional Counselors (LPCs), Licensed Social Workers (LSWs), and similar mental health specialists generally cannot bill 96127 under CMS guidelines because the CPT codes used for their services already include uncovering or monitoring mental health conditions. Check your state’s scope-of-practice rules for specific eligibility.
2026 Reimbursement Rates
| Payer Type | Rate Per Unit | Max Units/Visit | Max Per Visit |
|---|---|---|---|
| Medicare (national avg.) | $4.97 | 3 | $14.91 |
| Commercial | Varies by payer and contract | 3 | Varies |
| Medicaid | Varies by state | 3 | Varies |
CMS does not limit the number of times per year that 96127 may be billed. The Medically Unlikely Edit (MUE) limit of 3 units applies per date of service only. However, individual payers may impose their own annual frequency limits — always verify with each payer.
ICD-10 Codes for 96127
Most payers accept the generic screening ICD-10 codes from the Z13 family:
- Z13.31 — Encounter for screening for depression
- Z13.39 — Encounter for screening, other mental health conditions
- Z13.89 — Encounter for screening for other disorders
When screening results are negative, use the Z13.xx code that matches the condition screened. When results are positive, you may use either Z13.xx or the appropriate F-code (e.g., F32.xx for depression, F41.xx for anxiety) depending on payer preference.
Modifier Rules
When billing 96127 alongside an Evaluation and Management (E&M) code:
- Bill the E&M code first with modifier 25 (significant, separately identifiable E&M service)
- Bill 96127 last with modifier 59 (distinct procedural service)
This modifier pairing tells the payer that the screening was a separate, distinct service from the E&M visit. For detailed modifier examples and payer-specific guidance, download our complete billing guide.
96127 vs. G0444: Which Code to Use
The most common source of confusion is when to use 96127 versus G0444. The rule is straightforward:
- G0444: Use only during a Medicare Annual Wellness Visit (AWV). Covers annual depression screening. Medicare allowable is $18.25 (recommended charge: $41.95). Bill with 1 unit, no modifier. Use the AWV ICD-10 code.
- 96127: Use for all other visits — regular office visits, follow-ups, telemedicine, new patient visits. Covers any mental health condition. Bill up to 3 units.
Never bill 96127 on the same day as a Medicare Annual Wellness Visit. Use G0444 instead — it pays significantly more for AWV encounters.
Telemedicine Billing
As of January 2026, CMS has approved CPT 96127 for use with telemedicine through December 31, 2026. This means providers conducting virtual visits can administer screening instruments remotely (e.g., via patient portal or Connected Mind’s digital screening tool) and bill 96127 with the appropriate telehealth modifier.
Codes That Cannot Be Billed With 96127
Do not bill 96127 on the same date of service as:
- Medicare Annual Wellness Visit (use G0444 instead)
- 90791 (psychiatric diagnostic evaluation)
- 90792 (psychiatric diagnostic evaluation with medical services)
- 99406–99409 (smoking/tobacco cessation counseling)
- Any psychotherapy codes (90832, 90834, 90837, etc.)
- 96138, 96136, or 96130 (psychological testing codes)
These exclusions exist because the services represented by those codes already encompass or overlap with the behavioral assessment captured by 96127.
Documentation Requirements
While 96127 is designed as a high-volume screening code with minimal documentation burden, you should maintain records showing:
- Which standardized instrument was administered (e.g., PHQ-9, GAD-7, Connected Mind)
- The score for each instrument
- Clinical interpretation — whether results were positive or negative
- Any follow-up action taken based on results
Most payers do not require prior authorization for 96127. Under the Mental Health Parity and Addiction Equity Act, payers should not impose additional barriers on mental health screening that exceed those for comparable medical screenings. If a payer requests medical records or prior authorization for routine screening, providers can challenge these requirements through parity law enforcement channels.
How Connected Mind Simplifies 96127 Billing
Connected Mind® with Fast Check® screens for six common co-occurring mental health conditions quickly in a single encounter.
Official CMS Resources
Related Billing Resources
- CPT 96130 FAQ — Psychological testing evaluation services
- CPT 96136 FAQ — Test administration by a provider
- CPT 96138 FAQ — Test administration by a technician
- New CPT codes for psychological testing — Overview of the 2019 code changes
- Mental Health Parity Act — Your rights when payers deny claims
Frequently Asked Questions
What is CPT code 96127?
CPT 96127 is the billing code for brief emotional and behavioral assessment with scoring and documentation, per standardized instrument. It reimburses providers for screening patients using validated mental health tools like the PHQ-9, GAD-7, or multi-condition screeners like Connected Mind.
How much does CPT 96127 pay in 2026?
As of January 2026, the Medicare national average reimbursement for CPT 96127 is $4.97 per unit, with a maximum of 3 units per date of service ($14.91 total). Commercial payer rates vary but are typically higher than Medicare.
Who can bill CPT 96127?
Any physician or qualified healthcare professional can bill 96127. CMS defines a QHP as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice — there is no specialty restriction. Therapists and non-clinical social workers generally cannot bill 96127 under CMS guidelines.
Do I need to be a psychiatrist or psychologist to bill CPT 96127?
No. CMS defines a qualified healthcare professional as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice. Any physician or QHP meeting this definition may bill 96127 — there is no specialty restriction. Individual payer credentialing requirements may vary.
Can therapists or social workers bill CPT 96127?
Generally no. Licensed Professional Counselors (LPCs), Licensed Social Workers (LSWs), and similar mental health specialists generally cannot bill 96127 under CMS guidelines because the CPT codes used for their services already include uncovering or monitoring mental health conditions. Check your state's scope-of-practice rules for specific eligibility.
How many units of 96127 can I bill per visit?
The Medically Unlikely Edit (MUE) limit is 3 units per date of service. Each unit represents one standardized screening instrument administered and scored. CMS does not limit how many times per year 96127 may be billed, though individual payers may impose their own annual limits.
What is the difference between CPT 96127 and G0444?
96127 is for use with major medical visits or Medicare visits other than the Annual Wellness Visit. It covers any mental health condition screened. G0444 is for use only during the Medicare Annual Wellness Visit and covers annual depression screening only. G0444 typically pays about 3 times more than a single unit of 96127 ($18.25 Medicare allowable).
What ICD-10 codes should I use with 96127?
Most payers accept Z13.xx screening codes (Z13.31 for depression, Z13.39 for other mental health, Z13.89 for other specified conditions) when results are negative. When results are positive, you may use Z13.xx or codes beginning with F that correspond to the identified condition.
Which modifiers do I need when billing 96127?
When billing 96127 with an E&M code, bill the E&M code first with modifier 25 (significant, separately identifiable evaluation and management service). Bill 96127 last with modifier 59 (distinct procedural service).
Can I bill 96127 with telemedicine visits?
Yes. As of January 2026, CMS has approved CPT 96127 for use with telemedicine through December 31, 2026.
Can I bill 96127 together with 96138 or 96130?
No. Most payers, including Medicare, will not reimburse both 96127 and 96138, 96136, or 96130 on the same date of service. These codes represent different levels of psychological testing and should not be combined.
What codes cannot be billed on the same day as 96127?
Do not bill 96127 on the same day as a Medicare Annual Wellness Visit (use G0444 instead), 90791, 90792, 99406–99409, or any psychotherapy codes.
Can insurance companies require prior authorization for 96127?
Under the Mental Health Parity and Addiction Equity Act, payers should not impose additional barriers on mental health screening that do not exist for comparable medical screenings. However, some payers still request prior authorization or medical records. Providers can challenge these requirements through parity law enforcement.