Can 96127 be billed with a preventive visit?
Asked by: Wilfred Dare I | Last update: June 19, 2025Score: 4.2/5 (27 votes)
Is CPT code 96127 preventive?
G0444 can be billed for insurances which keeps Medicare policy for this service. All diagnostic codes are on the Medicare website. Service 96127 is not a preventive service. It is can be billed by specialist only (regarding credentialing list).
What are the billing requirements for 96127?
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.
Can you bill 96127 with 99214?
If multiple screenings are performed on a date of service CPT 96127 should be reported with the number of test as the number of Units. NOTE: Modifier 25 should be appended to the E/M and modifier 59 should be appended to the 96127 CPT code. For Example: 99214 25.
Can you bill an office visit with a preventive visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
How CPT Code 96127 Can Impact Your Income
What is the difference between a preventive visit and an office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Do you need modifier 25 with 96127?
Key Considerations for Reporting CPT 96127
To avoid issues, ensure that all services are reported correctly and use appropriate modifiers, such as modifier 25 for distinct E/M services performed on the same day.
Can 99214 and 93793 be billed together?
The CPT guidelines for code 93793 state: “Do not report 93793 on the same date of service as an E/M service." However, they also have the following parenthetical note: "(Do not report 93793 in conjunction with 99201,99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245)." We ...
When to bill G0444 vs 96127?
Routine (annual) screening (e.g., depression) when NO symptoms are present prior to screening – Use G0444 instead of 96127. Screening for depression when symptoms ARE present – Use CPT 96127.
Can you bill 90791 and 96127 together?
For example, a provider cannot bill 96127 along with cpt code 90791.
Can 96127 be billed for PHQ 2?
Please note the same CPT code (i.e. 96127) is used for both the abbreviated 2-question PHQ-2 instrument and the longer 9-question PHQ-9 instrument.
What is the difference between 96127 and 96160?
Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). However, code 96127 should be reported for both screening and follow-up of emotional and behavioral health conditions.
What diagnosis should be used with 96127?
You should report CPT code 96127, “Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument,” with one unit for each screening instrument completed, and be sure to document the instruments used ...
What is CPT code 93793 billing guidelines?
CPT code 93793 is used for the management of a patient who is on warfarin, a common anticoagulant medication. This code specifically refers to the process of evaluating and managing a patient's anticoagulation therapy.
What qualifies as a TCM visit?
Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy.
Can you bill an AWV and E&M together?
When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25.
Can I use modifier 25 on a preventive visit?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
Does insurance pay for 96127?
CPT Code 96127 is a generic mental health screening code that is covered by most major insurances. It is designed to pay for the evenly applied screening of a large patient population to uncover underlying mental health conditions.
How many RVUs is 96127?
The currently published relative value units (RVUs) for the codes being discussed are: 96110, 0.27; 96127, 0.16; 96160, 0.13; and 96161, 0.13.
Is 99213 preventive?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
How do you bill two E&M on the same day?
If you see a patient in separate settings on the same date of service, you should not add the time together, even if you were accustomed to billing that way for years. Instead, you can report two separate E/M codes with modifier 25 appended.