As a therapist, you don’t only provide therapy; you also conduct evaluations and assessments. Regardless of how long these assessments take to complete, you have the right to be compensated for them. Current Procedural Terminology (CPT) codes are maintained by the American Medical Association, (AMA) and are the standard way of billing for medical procedures. There is a range of CPT codes that are used for psychological testing and assessments. One of those codes is CPT code 96127. However, as a therapist, you won’t be using this code – so who can use it, and what should therapists use instead?
Per the AMA, 96127 is used to bill for “Brief emotional/behavioral assessment.” Specifically, it’s used for standardized questionnaires and assessment surveys to measure behavioral and/or emotional health. Instead of being billed per time, like some other codes, it’s billed per questionnaire or measurement tool.
This code is relatively new. It was created as part of the Affordable Care Act, which mandates that all insurance plans must include mental health services as part of their benefits. It ensures that health practitioners are screening their patients for mental health conditions as part of their services. Health professionals that may use CPT code 96127 include:
It can be used for patients of all ages, but it may be more frequently used for children and adolescents, who automatically get screened for mental health and substance use problems as part of their check-ups. It includes standard preventative screenings, even when the health professional does not observe any symptoms.
Health practitioners can only bill 96127 when they use a standardized tool or instrument and document its results. This is important to mention because many practitioners evaluate mental and behavioral health through other methods, such as a patient interview or observation of symptoms. Any assessment that does not use a standardized tool is not billed with 96127.
It may be confusing, but therapists, psychologists, and other mental health providers do not use 96127, even if you’re delivering a standardized questionnaire. This is because emotional and behavioral health evaluation is already inherently included in the services you provide as a mental health professional. Instead, this code is used for other health professionals who don’t always evaluate mental health as part of their regular services. For example, a pediatrician who conducts a depression screening for an adolescent patient might use this code.
Any standardized assessment tool or instrument specifically to measure symptoms of an emotional or behavioral health condition can be billed using CPT code 96127, including:
Note that developmental screenings for children are not billed as 96127. This code is only used for standardized screening instruments that are used across large patient populations. For example, you might screen everyone who comes in with gastrointestinal issues for anxiety.
Health professionals can bill for this code even if you simply gave the patient a self-questionnaire to fill out on their own.
Make sure you document important information, including:
96127 is unique among CPT codes as it’s billed per instrument and not per timed session. It is typically reimbursed at anywhere between $4 and $7 per instrument. Keep in mind that this is just for the delivery of the screening. You can bill 96127 alongside other health services, including other evaluation and monitoring services.
Here are some of the most common mistakes that health professionals make when using CPT code 96127, and how to avoid them.
| Mistake | What to do instead |
|---|---|
| Billing 96127 as a therapist or clinical social worker. | Mental health professionals who deliver behavioral health services as their primary job cannot bill 96127. Simply bill for the psychotherapy or assessment service you delivered. |
| Billing too many times for 96127 per day. | How many times you can bill 96127 per patient per day depends on the insurance plan. Medicare only allows you to bill this code twice per day. |
| Using 96127 for autism evaluation. | Autism evaluation has its own set of codes depending on the exact type of screening and the license of the person providing it. Do not bill 96127 for autism screening. |
| Billing 96127 when you evaluated a patient through a clinical interview. | 96127 is only for standardized screening instruments, not evaluation. |
Here are the answers to some common questions that mental health providers have about this code.
How many times can 96127 be billed?
Under most insurance plans, 96127 can be billed twice per day, and four times per year per patient. Check with the insurance plan for specific information.
Can you bill 97127 for PHQ-9?
Yes, PHQ-9 is a standardized health questionnaire that can be billed under 96127.
Can 96127 be billed with 99214?
Yes, 96127 and 99214 are frequently billed together. 99214 is the code used for established patient office visits that last 30 to 39 minutes. So if an established patient comes to your office for a check-up and you deliver a standardized screening instrument, then both of these codes would be billed.
Can 90833 and 96127 be billed together?
Usually, 90833 and 96127 cannot be billed together because 90833 is a psychotherapy code, and therapists cannot bill 96127. There may be some exceptions – check with your billing office or insurance provider for more information.
What is the difference between 96127 and 96160?
96127 is specifically used to screen for mental, emotional, and behavioral health problems. 961690 is the code that’s billed for standardized health risk questionnaires pertaining to physical or general health.
How much does Medicare pay for 96127?
Medicare reimburses 96127 at $4.57 per instrument.
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American Academy of Family Physicians, Getting Paid for Screening and Assessment Services
American Academy of Pediatrics, Coding for Standardized Assessment, Screening and Testing
American Medical Association, Behavioral Health Coding Resource
American Psychological Association, 2024 Physician Fee Schedule final rule released
American Psychological Association, Psychotherapy Codes for Psychologists
Centers for Medicare and Medicaid Services, Search the Physician Fee Schedule