Billing for Mental Health Screening (2026)
Mental health screening is billable to most major insurers using standard CPT codes. The screening itself bills under CPT 96127. If targeted testing is triggered by a positive screen, test administration bills under 96138 (technician) or 96136 (provider), and test evaluation bills under 96130. During Medicare Annual Wellness Visits, depression screening bills under G0444 instead of 96127.
This guide walks through the complete billing workflow from screening through testing, with the exact codes, modifiers, ICD-10 pairings, and documentation requirements at each step. For detailed information on any individual code, see the CPT codes overview.
The Complete Billing Workflow
Step 1: Administer a Validated Screening Instrument
The billing workflow begins when a validated screening instrument is administered to a patient during a visit. The instrument can be administered by:
- The physician or qualified healthcare professional directly
- A medical assistant, nurse, or clinical staff member under the billing provider’s supervision
- The patient via a digital portal, tablet, or kiosk in the waiting room
The key requirement is that the instrument must be validated and standardized. Common instruments include the PHQ-9 (depression), GAD-7 (anxiety), ASRS (ADHD), and Connected Mind (six conditions simultaneously). Connected Mind screens for depression, anxiety, ADHD, bipolar disorder, substance use disorder, and somatic symptom disorder in approximately one minute.
Step 2: Score and Document Results
After the screening is administered, the billing provider (or their staff under supervision) must:
- Score each instrument according to its standardized scoring protocol
- Document which instrument(s) were administered
- Record the score for each instrument
- Note the clinical interpretation — positive or negative for each condition screened
- Document any follow-up action — referral, further testing, watchful waiting, etc.
Connected Mind automates scoring and generates a clinical report with all required documentation elements. For manual instruments like the PHQ-9, the provider must record the total score and threshold interpretation (e.g., PHQ-9 score of 12 = moderately severe depression).
Step 3: Select the Correct CPT Code
| Visit Type | Code | Rate (2026 Medicare) |
|---|---|---|
| Regular office visit, follow-up, new patient, telehealth | 96127 | $4.97/unit (max 3 = $14.91) |
| Medicare Annual Wellness Visit (depression screening) | G0444 | $18.25 |
This is the most common billing mistake: using 96127 during a Medicare AWV instead of G0444. G0444 pays nearly 4x more than a single unit of 96127 and is the designated code for AWV depression screening. Never bill 96127 on the same day as an AWV.
With Connected Mind, a single screening session covers six conditions simultaneously, supporting up to 3 units of 96127 per visit. Single-condition screeners like the PHQ-9 or GAD-7 typically support 1 unit.
Step 4: Apply Modifiers
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 pattern tells the payer that the screening was a separate, distinct service from the office visit. Missing modifiers are the #1 cause of 96127 claim denials.
Step 5: Pair with the Correct ICD-10 Code
| Screening Result | ICD-10 Code | Description |
|---|---|---|
| Depression screening, negative | Z13.31 | Encounter for screening for depression |
| Other mental health screening, negative | Z13.39 | Encounter for screening, other mental health |
| General behavioral screening, negative | Z13.89 | Encounter for screening, other specified |
| Positive depression screen | Z13.31 or F32.xx | Screening code or condition code |
| Positive anxiety screen | Z13.39 or F41.xx | Screening code or condition code |
Important: Do not use the same ICD-10 code for both your E&M service and 96127, or the payer may consider 96127 bundled with the E&M and deny the screening claim.
Step 6: Submit the Claim
A typical claim for a screening visit looks like this:
| Line | Code | Modifier | ICD-10 | Units |
|---|---|---|---|---|
| 1 | 99213 (or applicable E&M) | 25 | Visit condition | 1 |
| 2 | 96127 | 59 | Z13.31, Z13.39 | 1–3 |
For a Medicare AWV with depression screening:
| Line | Code | Modifier | ICD-10 | Units |
|---|---|---|---|---|
| 1 | G0438/G0439 (AWV) | — | AWV ICD-10 | 1 |
| 2 | G0444 | — | AWV ICD-10 | 1 |
When Screening Is Positive: The Testing Workflow
A positive screening result is a flag, not a finding. It indicates further evaluation is warranted. When a provider decides to order formal psychological testing based on a positive screen, the testing uses different codes on a separate date of service.
Test Administration (96136 or 96138)
| Scenario | Code | Rate (2026 Medicare) |
|---|---|---|
| Provider administers tests personally | 96136 | $43.94/first 30 min |
| Technician administers under supervision | 96138 | $37.73/first 30 min |
Both codes require a minimum of 16 minutes of total time and cover two or more tests. Additional 30-minute increments bill under 96137 (provider) or 96139 (technician).
With Connected Mind, when any condition screens positive, the system automatically launches Standardized Assessment Modules (SAMs) for that condition. The SAMs component may bill under 96136 or 96138 depending on who oversees the administration.
Test Evaluation (96130)
After tests are administered, the physician or QHP evaluates the results:
| Code | Description | Rate (2026 Medicare) |
|---|---|---|
| 96130 | Testing evaluation, first hour | $124.74 |
| 96131 | Testing evaluation, each additional hour | Varies |
96130 covers interpreting test results, integrating clinical data, clinical decision-making, report writing, and interactive feedback. The minimum time requirement is 31 minutes of total time (not face time).
96130 may be performed on a different day from 96136/96138. The administration and evaluation do not need to occur in the same encounter.
Testing Claim Example
| Line | Code | Modifier | ICD-10 | Units |
|---|---|---|---|---|
| 1 | 99213 (or applicable E&M) | 25 | Visit condition | 1 |
| 2 | 96138 | 59 | Mental health F-code | 1 |
| 3 | 96130 | 59 | Mental health F-code | 1 |
Do not use the same ICD-10 codes for both the E&M and the testing codes, or the payer may consider the testing bundled.
The 5 Most Common Denial Reasons (and How to Fix Them)
1. Missing or Incorrect Modifiers
The problem: The E&M code is missing modifier 25, or 96127 is missing modifier 59.
The fix: Always bill the E&M code first with modifier 25, then 96127 with modifier 59. Build this into your billing workflow or EHR templates so it happens automatically.
2. Billing 96127 During an Annual Wellness Visit
The problem: The provider billed 96127 instead of G0444 during a Medicare AWV. Medicare denies 96127 when billed on the same date as an AWV.
The fix: Use G0444 for all depression screening during AWVs. G0444 pays $18.25 — nearly 4x more than a single unit of 96127.
3. Combining Screening and Testing on the Same Day
The problem: 96127 was billed on the same date as 96130, 96136, or 96138. These codes are mutually exclusive per date of service.
The fix: Screen on one visit (96127), test on a subsequent visit (96136/96138 + 96130). Schedule testing as a separate encounter.
4. ICD-10 Code Duplication
The problem: The same ICD-10 code was used for both the E&M service and 96127. The payer considers 96127 bundled with the E&M and denies it.
The fix: Use Z13.xx screening codes on the 96127 line item. Use the primary visit condition code on the E&M line item. Keep them separate.
5. Exceeding the MUE Limit
The problem: More than 3 units of 96127 were billed on a single date of service.
The fix: The Medically Unlikely Edit (MUE) caps 96127 at 3 units per date of service. Each unit represents one standardized instrument administered and scored. If you screen for more than 3 conditions using separate instruments, bill a maximum of 3 units. Connected Mind covers six conditions in one screening session — supporting up to 3 units within the MUE limit.
Parity Protections: When Payers Push Back
Under the Mental Health Parity and Addiction Equity Act, health insurers cannot impose restrictions on mental health services that are more limiting than those applied to comparable medical services. If a payer:
- Requires prior authorization for routine mental health screening (but not for comparable medical screenings)
- Imposes annual frequency limits that exceed those for other preventive screenings
- Requests medical records before authorizing 96127 claims
These practices may violate parity law. Providers can file complaints with their state insurance commissioner or through CMS enforcement channels. The parity act applies to most commercial insurers, Medicaid managed care plans, and CHIP programs.
Connected Mind: Simplifying the Entire Workflow
Connected Mind® with Fast Check® streamlines every step of the billing workflow described in this guide. A single multi-condition screening session covers six mental health conditions in approximately one minute, automatically launches Standardized Assessment Modules (SAMs) when any condition screens positive, and generates clinical documentation with all required billing elements.
Official CMS Resources
Related Billing Resources
- CPT codes for mental health screening: 2026 guide — Complete overview of all screening and testing codes
- CPT 96127 FAQ — Brief emotional/behavioral assessment billing guide
- CPT 96130 FAQ — Psychological testing evaluation services
- CPT 96136 FAQ — Test administration by a provider
- CPT 96138 FAQ — Test administration by a technician
- Mental Health Parity Act — Your rights when payers deny claims
- Billing quick reference — All codes at a glance
Frequently Asked Questions
How do I bill for mental health screening in primary care?
Bill mental health screening under CPT 96127 (brief emotional/behavioral assessment with scoring and documentation, per standardized instrument). Administer a validated screening tool, score it, document the results, and bill 96127 with modifier 59 alongside your E&M code with modifier 25. Each unit of 96127 represents one standardized instrument. As of 2026, Medicare reimburses $4.97 per unit with a maximum of 3 units per date of service ($14.91 total).
What is the step-by-step workflow for billing mental health screening?
Step 1: Administer a validated screening instrument (e.g., Connected Mind, PHQ-9, GAD-7). Step 2: Score and document results. Step 3: If positive, consider ordering formal testing on a subsequent visit (96136/96138 for administration, 96130 for evaluation). Step 4: Bill the E&M code first with modifier 25, then 96127 with modifier 59. Step 5: Use ICD-10 codes Z13.31 (depression), Z13.39 (other mental health), or Z13.89 (other screening) for negative results; F-codes for positive results.
Which CPT code do I use for mental health screening during a regular office visit?
Use CPT 96127 for mental health screening during any regular office visit, follow-up, new patient visit, or telemedicine encounter. Bill it alongside your E&M code. Do not use G0444 — that code is reserved exclusively for depression screening during a Medicare Annual Wellness Visit.
Which CPT code do I use for depression screening during a Medicare Annual Wellness Visit?
Use G0444 for depression screening during a Medicare Annual Wellness Visit (AWV). G0444 pays $18.25 — significantly more than a single unit of 96127 ($4.97). Never bill 96127 on the same day as an AWV. With Connected Mind, G0444 covers the depression screening component while the tool simultaneously screens for five additional conditions.
How do I document mental health screening for billing?
Document four elements for every screening: (1) which standardized instrument was administered (e.g., Connected Mind, PHQ-9, GAD-7), (2) the score for each instrument, (3) clinical interpretation — whether results were positive or negative for each condition screened, and (4) any follow-up action taken based on results. Connected Mind generates this documentation automatically as part of the screening workflow.
What are the most common reasons mental health screening claims are denied?
The five most common denial reasons are: (1) missing or incorrect modifiers — the E&M code needs modifier 25 and 96127 needs modifier 59; (2) billing 96127 on the same day as an AWV instead of using G0444; (3) billing 96127 on the same day as 96130, 96136, or 96138 (screening and testing cannot be billed together); (4) using an ICD-10 code that duplicates the E&M condition code; and (5) exceeding the MUE limit of 3 units per date of service.
Can I bill for mental health screening at every visit?
CMS does not limit the number of times per year that CPT 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. Most commercial payers allow screening at regular intervals (annually or more frequently when clinically indicated). Check with each payer for their specific policies.
What happens when a screening is positive — how do I bill the follow-up testing?
When screening flags a positive result, you may order formal psychological testing on a subsequent visit. Bill 96136 ($43.94/30 min) if the provider administers the tests, or 96138 ($37.73/30 min) if a technician administers under supervision. Bill 96130 ($124.74/hour) for the provider's evaluation and interpretation of test results. Important: do not bill testing codes (96130, 96136, 96138) on the same date of service as screening (96127).
Do I need to be a specialist to bill for mental health screening?
No. Any physician or qualified healthcare professional (MD, DO, PA, NP, DNP, PhD, PsyD) can bill CPT 96127 for mental health screening. 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. Primary care providers bill the majority of 96127 claims.
Can I bill for mental health screening during telehealth visits?
Yes. As of January 2026, CMS has approved CPT 96127 for telemedicine through December 31, 2026. Providers can administer screening instruments remotely via patient portal or digital link and bill 96127 with the appropriate telehealth modifier. Connected Mind supports remote administration with data from more than 4,000 remote encounters demonstrating clinically nuanced results.
What if a payer denies my mental health screening claim?
First, verify modifiers (25 on E&M, 59 on 96127), ICD-10 code pairing (use Z13.xx screening codes, not the same F-codes as your E&M), and that you did not bill 96127 alongside excluded codes (G0444, 96130, 96138, psychotherapy codes). If the denial appears to impose a barrier that does not exist for comparable medical screenings, the Mental Health Parity and Addiction Equity Act may apply. Providers can challenge parity violations through their state insurance commissioner or CMS enforcement channels.
Is prior authorization required for mental health screening?
Most payers do not require prior authorization for CPT 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 prior authorization or medical records for routine screening, providers can challenge the requirement through parity law enforcement channels.
What screening tools are accepted for CPT 96127 billing?
CPT 96127 can be billed for any validated, standardized screening instrument. Common tools include the PHQ-9 (depression), GAD-7 (anxiety), ASRS (ADHD), MDQ (bipolar), CAGE-AID (substance use), PHQ-15 (somatic symptoms), and Connected Mind (six conditions simultaneously). The instrument must be validated and the results must be scored and documented.
Can my medical assistant or nurse administer the screening?
Yes. A medical assistant, nurse, or other clinical staff member can administer the screening instrument under the supervision of the billing provider. The billing provider (physician or QHP) is responsible for reviewing the results, documenting clinical interpretation, and determining follow-up. The screening does not need to be face-to-face with the billing provider — digital administration via patient portal or tablet in the waiting room is accepted.