What Is CPT Code 96127 and How Does It Affect Your Income?

Brief behavioral assessments are a great way for behavioral health professionals and other clinicians to gauge risk and progress, but many of them don't bill for it or conduct these screenings at all. That might mean leaving money on the table and missing out on valuable insights. CPT 96127 offers a simple reimbursement process that helps providers maximize the value of these assessments.

Let's take a closer look at CPT Code 96127, including what billing requirements look like and how it can help your practice.

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What Is CPT Code 96127?

CPT 96127 is a billing code used for administering screenings, such as the Patient Health Questionnaire (PHQ-9). The CPT code 96127 description covers brief emotional or behavioral assessments performed with standardized instruments. It includes scoring and documentation and refers to tools like depression inventories, substance abuse risk screenings and attention-deficit/hyperactivity disorder (ADHD) scales. You can use it as part of initial screening or as a method of monitoring.

This code is fairly versatile, as you can use it:

  • With adults, children and adolescents.
  • For patients already being treated for mental illness.
  • For patients with complex medical issues.
  • At any point during care, including post-hospitalization or new diagnoses.
  • With most major insurance providers, including Medicare.
  • When administered by a qualified healthcare professional, not just psychiatrists.
  • With multiple assessments — up to four — per session.

Of course, some payers may have specific requirements for reimbursing this code, but for the most part, this is a broad code offering more billing opportunities for mental health providers and other clinicians. It functions as a CPT code for anxiety screening, depression scales, substance abuse testing and many other screens.

There is no specific list, but some screenings commonly used with CPT 96127 include:

  • Ages and Stages Questionnaire: Social-Emotional (ASQ:SE).
  • Behavior Assessment Scale for Children — Second Edition (BASC-2).
  • Behavior Rating Inventory of Executive Function (BRIEF).
  • Connor's Rating Scale.
  • Patient Health Questionnaire (PHQ-2 or PHQ-9).
  • Pediatric Symptom Checklist (PSC).
  • Substance Abuse and Alcohol Abuse Screening (CRAFFT).
  • General Anxiety Disorder scale (GAD-7).
  • Alcohol Use Disorders Identification Test (AUDIT).
  • Columbia-Suicide Severity Rating Scale (C-SSRS).

What is a CPT code?

How CPT Code 96127 Can Help You

CPT offers benefits for both behavioral health providers and other clinicians, primarily as a source of reimbursement. Although the average reimbursement value is about $6 per screen, it can be used up to four times per visit and is a simple way to increase reimbursements while collecting more data. In many cases, patients can even fill out these screens themselves. When used routinely, the value can add up.

CPT 96127 was initially created as a part of the Affordable Care Act's mandate to include mental health services as part of the essential benefits insurance plans must cover. Its flexibility lets providers outside of behavioral health offer these brief screenings as part of everyday care. For example, a primary care physician (PCP) might administer the PHQ-9 to look for symptoms of depression during an annual visit. This code can be used alongside other services.

Although many behavioral health clinicians conduct more in-depth assessments during initial appointments, CPT 96127 is often used to assess progress over time. These quick screenings can be performed at every session, delivering a steady stream of data to inform treatment plans and outcome measurement.

In many cases, these screenings don't even need to be administered by clinical staff, just interpreted by them. Since CPT 96127 is quick and broad, you can use it to easily increase reimbursements while collecting more data and, ideally, improving patient outcomes. As payers move toward outcomes-based reimbursement models rather than fee-for-service models, this kind of data collection will be increasingly important. CPT Code 96127 can help you receive compensation while building up your data and shifting to this assessment style.

CPT Code 96127 Requirements

CPT 96127 doesn't have many requirements, but it does need to be provided and scored by trained administrative staff, an MD, a technician, a computer or a qualified health professional. There is no specific time length required for it, and you can use a wide range of standardized assessments. You can typically use it alongside other procedures like initial assessments and psychotherapy codes. CPT code 96127 may have documentation requirements that ask you to indicate which service or assessment was rendered.

Some insurance companies have their own requirements for reimbursement, so check with your payers to see what is needed. Some providers will only reimburse up to two screens per visit.

Remember, CPT 96127 is appropriate for brief, short assessments. Often, behavioral health providers find that more comprehensive assessments are necessary. In these instances, CPT 96127 would not be applicable.

Frequently Asked Questions About CPT Code 96127

Below are some commonly asked questions for CPT 96127.

What's the Difference Between CPT 96127 and G0444?

G0444 has a similar scope but is used as a preventive service for Medicare patients not currently displaying symptoms. It is often used during annual visits. For non-Medicare patients or Medicare patients displaying signs or symptoms, CPT 96127 is appropriate.

What ICD-10 Code Should I Use?

The ICD-10 code for CPT 96127 depends on the diagnosis. If you're using it to investigate a behavioral health symptom, use the code for that symptom. If performing a general screening, such as during an annual wellness visit, you can use ICD-10 code Z13.39, a more generalized screening option for “other” mental health and behavioral disorders.

Can You Use CPT 96127 With Telemedicine Services?

Using this code for telemedicine depends on the conditions of the payer. For many providers, including Medicare, you can bill CPT 96127 through telemedicine services. Keep in mind that for some, this is a temporary addition due to COVID-19 and may change in the future.

How Should I Bill CPT 96127 if the Test Was Scored on Another Day?

Since this code encompasses administration and scoring, you should report it with the date those services were completed.

Should I Use Modifiers With CPT 96127?

Depending on the payer, you may need to use modifier 59 to indicate the screening was distinct or independent from other non-evaluation and management services. Include documentation to support.

Optimize Your Billing With ICANotes

Optimize Your Billing With ICANotes

CPT 96127 is just one of many codes providers often overlook or bill for inefficiently. With the right tools, you can optimize your billing to pave the way for better data collection and higher reimbursements. ICANotes is an electronic health record (EHR) designed for behavioral health providers, with a range of tools to boost your reimbursement, efficiency and quality of care. It simplifies and streamlines billing for therapists and other mental health providers, so you can spend less time on paperwork and more time with your patients.

If you're ready to start using CPT 96127 to your advantage, ICANotes can help. Reach out today to set up your free trial and see for yourself.

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