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CPT Code 96127 – Answers to the frequently asked questions about billing this code

Although it has only been around since early 2015, CPT Code 96127 has been getting more and more attention only recently. However, with not a lot of experience with billing this code, many providers still don’t want to bill it, and even if they wanted to, they don’t know how. Our customers have successfully billed this code. Therefore, we’d like to share our experience and answer the most common questions that you may have about billing CPT code 96127.

Disclaimer: Please note that the answers describe our own experiences and that of our clients who have successfully used Mentegram to improve their practice efficacy. Different criteria may apply, based upon variables such as practice location, patient diagnosis and insurance carrier. We encourage you to discuss the specifics of billing codes with your office managers and billing services. By reading further, you acknowledge that this post isn’t considered a legal advice. The authors and Mentegram don’t take any liability for your decisions and actions after reading this post.

Let me start with the brief description that I borrowed from the APA Practice Central website. The CPT code 96127: Brief emotional/behavioral assessment (for example, depression inventory, ADHD scale), with scoring and documentation, per standardized instrument. It should be used to report a brief assessment for ADHD, depression, suicidal risk, anxiety, substance abuse, eating disorders, etc., and it covers services such as depression screenings for adults and adolescents, alcohol misuse in adults, alcohol and drug use in adolescents, and behavioral assessments in children and adolescents.

What is the process for billing CPT code 96127?

  1. Assign the assessment to the patient through Mentegram
  2. Patient submits forms through tablet or computer
  3. Review results and generate report in Mentegram
  4. Attach as a lab report to the e-claim in your EHR

Billing CPT code 96127

Who can bill CPT code 96127?
Screening and assessment has to be completed under an MD supervision, and a MD needs to file the report. It means that, for example, primary care physicians can also bill it – not only psychiatrists.

What conditions can be included?
Mentegram can be used to screen for and assess conditions listed in ICD-10 and DSM-V.

When can I screen patients and bill for that?
Patients can be screened and billed in any of the following: post hospitalization, new diagnosis or complex medical issue, patients with pain, patients with substance abuse, and patients diagnosed with or being treated from mental illness.

How often can we bill CPT code 96127?
It can be billed every time when it’s medically necessary, with a maximum of 4 different screens per visit.

How much is paid for CPT code 96127?
96127 can bill close to $25.

Who pays for CPT code 96127 and accepts Mentegram for higher complexity visits?
Humana, Cigna, Aetna, Athena, Medicare and others may be used. Please double-check with your billing team.

Is there something else that the screening and assessments can help me with?
Standardized screening and assessments tools aid in Risk Management and Quality of Care, as well as Practice/Organizational Marketing.

If you are interested in learning more about the CPT code 96127 and how Mentegram can help you, continue here:

DISCLAIMER: Please keep in mind that Mentegram is a software company, and do not consider content on our website as legal advice. It is your responsibility to decide to act on this content, relinquishing Mentegram of all claims. The information that we share is either what has worked well for our customers or curated content of the best practices from authorities.
We don’t consider ourselves billing consultants and experts. If you aren’t sure, please consult the particular insurance company or billing consultant for additional information.