Billing Guide

Billing Guide for Psychological Screening and Testing

Connected Mind has assembled a billing guide to help you with the latest codes related to psychological screening and testing in your practice.
It includes codes, definitions, and guidelines, along with examples and sample documentation.

Download The Latest Billing Guide

Billing Tips

Below are some tips for billing when using Connected Mind’s mental health screening and testing tool 

Connected Mind Clinical Report

Billing Is Divided Into Two Sections

One

Screening

VS

Testing

Connected Mind Screening Report

Screening

  • If no conditions are triggered it is considered screening – results are lime green with no “Standard Results”.
  • If ONLY one condition is triggered and is NEGATIVE it is considered screening – result has a colored gas gauge with a “Normal” or “Criteria Not Met” result
  • Screening is billed as 96127 with a modifier 59 and 3 units – each condition screened is a unit. Even though we screen for 6 conditions Medicare Unlikely Edits (MUE) limits the number of conditions to 3
  • 96127 should be billed with an ICD10 code of Z13.XX
Billing 96138

Testing

  • If at least TWO conditions are triggered it is considered testing – result has a colored gas gauge and a “Standard Result” exists
  • Testing is billed as 96138 with a modifier of 59 – 96127 should not be billed with 96138
  • 96138 indicates the service is being performed by a person under the supervision of a Provider. Use 96136 if the service is performed by the actual Provider

Reporting And Interpretation

Billing 96130

Reporting And Interpretation

  • If at least ONE condition is positive and the Provider performs the required service it is considered Reporting & Interpretation – result has a colored gas gauge with a score other than “Normal” or “Criteria Not Met”
  • Reporting & Interpretation is billed as 96130 with a modifier of 59 – 96130 can be billed with 96138 but 96127 should not be billed with 96130
  • Provider must document 96130 properly or the claim will be denied – see the current billing guide
Tips For Billing Mental Health

Additional Tips

  • For the most efficient workflow MAs should document the testing or screening
  • Providers may not delegate the service for 96130
  • Do not use the same ICD10 code for the E&M as you do for 96138 or 96130 – The services performed as part of the E&M must be clearly separate and distinct from the services performed for 96138 and 96130 – No double dipping!