What is CPT code 96127 and how should it be used for mental health screenings?

96127 is a brief standardized assessment code for behavioral/emotional conditions. Use it when you administer a validated instrument, score it, and document the instrument name, score, interpretation, and plan. Bill per instrument; pair with E/M or psychotherapy when allowed; follow payer guidelines on units and modifiers.

Which standardized screening tools can be billed under CPT 96127?

Examples include PHQ-9/PHQ-2, GAD-7/GAD-2, AUDIT/AUDIT-C, DAST-10, CRAFFT, PSC, SDQ, Vanderbilt, EPDS, SCARED, PCL-5 (screening cutoffs), and C-SSRS screening forms. Ensure standardization, scoring, and documentation.

Who is eligible to bill 96127—therapists, social workers, or only physicians?

Eligibility varies by payer and state. Physicians, NPs, PAs, and clinical psychologists are commonly recognized; LCSW/LMFT/LPC coverage varies. Verify scope, enrollment, and plan policy.

What are the documentation and compliance requirements for 96127?

Document tool name, who completed it, date/time, score, interpretation, provider review, and plan; add modifier-25 to E/M if required.

How many units can be billed per patient and per date of service?

Bill per instrument; many plans cap 2–4 units per DOS. Follow plan rules for units and modifiers.

Is CPT 96127 reimbursed by Medicare, Medicaid, and commercial insurances, and at what rates?

Generally yes, with locality- and plan-specific rates. Check MPFS and state Medicaid fee schedules.

Can CPT 96127 be billed via telehealth or remote assessments?

Often yes, when covered by the payer with correct POS and modifiers. Confirm current status on the CMS Telehealth List; document remote administration and real-time review.

What ICD-10 diagnosis codes should be used when billing CPT 96127?

Use Z13.31/Z13.39/Z13.30 for screening; add relevant F-codes for positive findings.

How does CPT 96127 differ from other behavioral health screening codes?

96127 = brief behavioral/emotional screening; G0444 = Medicare annual depression screening; 96110 = developmental screening; 96160/96161 = health risk assessments.

Can CPT 96127 be billed on the same day as E/M, psychotherapy, or annual wellness codes?

Often yes with E/M (modifier-25 may be required) and sometimes psychotherapy (payer-specific). For AWV, use G0444 for annual Medicare depression screening.