CPT Code 96127: Improving Patient Care and Your Bottom Line

CPT Code 96127: Improving Patient Care and Your Bottom Line

In January 2015, CMS implemented CPT code 96127. The code was part of the ACA’s mandate that mental health treatment be part of the essential benefits provided by insurers.

Many clinicians are excited about the ability to use technology to measure their patients’ progress and enhance engagement. One thing that may be holding them back is the cost of implementing these solutions. The good news is that because these services improve patient care and outcomes it is possible to bill for them using CPT code 96127.

Not sure how to use this code? Want to start using technology in your practice and aren’t sure how to bill for it? Read on for some tips.

What is CPT Code 96127?

CPT code 96127 is for the administration, scoring, and documentation of a brief behavioral/emotional screening.

What types of assessments would qualify for 96127?

Examples of these screeners are the PHQ-9, GAD-7, AUDIT, and DASS-21. Essentially, these are brief measures used to assess for depression, anxiety, suicide risk, substance abuse, ADHD, eating disorders, etc.

How do I use code 96127?

The code is per screen administered. You can bill for up to 4 screeners per patient, per visit, and can be reimbursed up to $6 per screen, so up to $24 per visit.

Do I need to administer the assessment?

No, the assessment can be given/scored by trained administrative staff.

Is it really worth it?

We think so. If you used 2 assessments with 10 clients on a weekly basis, and were reimbursed $6 per assessment, you would easily cover the cost of the software used to administer the assessments. Assuming four visits/month, that would be $480 per month of additional revenue.

Aside from financial reasons, the use of these measures can help improve client engagement, and studies have shown that practitioners aren’t always able to detect client decompensation. Furthermore, measurement-based care has been shown to improve outcomes. Now that it’s possible to get reimbursed for the administration and scoring of these measures, why not do it?

What insurance companies will reimburse for this code?

Many major insurance companies reimburse for 96127 including Aetna, Cigna, Medicare, United Healthcare, and others.

What’s the best and easiest way to administer these measures?

Pacifica offers a library of publicly-available standardized measures in its Clinician Dashboard.

Note:

It’s important to remember that reimbursement rates will vary, and providers should check with carriers to determine what the reimbursement rate is for the companies they are billing. This blog post does not constitute legal advice.