As of 1-1-15 you can bill for screening tests – with limitations

As of 1-1-15 CMS added a new billing code, 96127,  which is similar to the existing testing codes, but which is for screening, not testing. The American Psychological Association Practice Organization (APAPO) provided a guidance document about new testing codes that includes information about the 96127 code:

CPT code 96127: Brief behavioral assessment

Code 96127: Brief emotional/behavioral assessment (for example, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument, is new for 2015.

This code should be used to report a brief assessment for ADHD, depression, suicidal risk, anxiety, substance abuse, eating disorders, etc. This code was created in response to the Affordable Care Act’s federal mandate to include mental health services as part of the essential benefits that must be included in all insurance plans offered in individual and small group markets. The mandate covers services such as depression screening for adults and adolescents, alcohol misuse in adults, alcohol and drug use in adolescents, and behavioral assessments in children and adolescents.

I contacted CMS and Minnesota DHS, and confirmed that both have added this code to their benefits set.  I also contacted a few commercial companies and learned that they had not added this code to the benefits that, and in fact the staff did not seem aware of this code.  This brings up some interesting questions about whether this is in compliance with the ACPPA (Affordable Care and Patient Protection Act).  On the other hand, MCOs with PMAP contracts are allowed some time to update their benefits set, and I believe that this is usually about one half year so hopefully this code will start appearing on their benefits set soon. It will be interesting to see if they added to their regular commercial plans.
Unfortunately, reimbursement for this code, when it is recognized by a pair, is quite low, from from about $4.50 to $6.00. at least this provide some reimbursement for what in the past had been screening tests fit we had to provide for free.
Update, 6-20-15:  I recently submitted my first claims for 96127 to Medicare, they were not paid, and I called my local Medicare administrator, National Government Services to find out why.  I learned that they were not actually denied, but were categorized as “non-processable” because I had not included mandated information about the “referring physician” in sections 17 and 17a of the HCFA form, which require the name and NPI of the referring MD.  I also learned, as one of the many wonders of Medicare policies, that I can be the referring physician.  I also contacted all of the major local MCOs and learned that all have added 96127 to their fee schedule, but most of them were not able to tell me how much it pays as this important fact had not yet been established.  I was told by several of them something to the effect of, “Don’t worry, it is covered, just submit your claims and see what happens.”
Stay tuned for future updates.

 

2 Responses to “As of 1-1-15 you can bill for screening tests – with limitations”

  1. geoff gray says:

    do you know if psychologists can bill commercial carriers for 96127? 4 brief instruments can be administered together and would be paid at around $25. an automated assessment at or near intake would result in significant revenue if psychologists and others could bill for this code.

    • Richard Sethre, Psy.D., L.P. says:

      Thanks to Geoff for an excellent, savvy question. It is my understanding that commercial carriers may or may not have 96127 included in their fee schedule. Unfortunately, you would need to either review each carrier’s fee schedule or call their provider relations department. That’s what I would do. Richard Sethre, Psy.D., L.P.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>