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Procedure Codes for Screening and Assessment Services

Procedure Codes for Screening and Assessment Services

In year 2017, CMS updated procedural codes for structured screenings and brief assessments to expand coverage of these services. If you are not billing for these services, you may be losing out on valuable revenue. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. In this article, we have discussed four procedure codes for structured screenings and brief assessments along with basic guidelines.

CPT Codes for Screening and Assessment Services

Four codes are used to report structured screening and assessments are as follows:

  • CPT Code 96110: Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument.
  • CPT Code 96127: Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument.
  • CPT Code 96160: Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument.
  • CPT Code 96161: Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument.

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. These codes do not represent physician work. For payment purposes, each screening and assessment code was valued based on practice expense and professional liability only, which includes the cost of furnishing instruments (when applicable) and staff time to administer and/or score an instrument for the physician or other qualified health care professional’s review. The physician’s interpretation of the score in light of the patient presentation is considered part of the evaluation and management (E/M) service, which would be billed in addition to the screening or assessment code.

CPT Code 96110: Developmental Screening

Developmental screening reported with code 96110 is paid for by 45 state Medicaid programs with rates varying from approximately $5 to $60. Many private insurers also provide preventive benefits for code 96110 for developmental screening at nine months, 18 months, and 30 months, and autism screening at 18 months and 24 months in addition to the recommended preventive medicine E/M services (e.g., well-child visits). Developmental surveillance without use of a structured screening instrument is included in the preventive medicine service and not separately reported. Most payers allow two ‘units’ (i.e., instruments) per date of service for code 96110.

CPT Code 96127: Emotional and Behavioral Health Assessments

Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. For instance, Aetna has a long-standing policy to cover depression screening in primary care when the service is performed using the Patient Health Questionnaire-9 (PHQ-9) tool and is reported with code 96127.

An annual depression screening of up to 15 minutes is covered for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. Code G0444 should be reported to Medicare Part B administrative contractors for this purpose instead of code 96127, and the time spent on screening and discussing results and recommendations should be documented. Depression screening is not separately reported in conjunction with a Medicare initial preventive physical examination or an initial Medicare annual wellness visit (AWV). Payer guidance for reporting postpartum depression screening also varies. Many Medic-aid plans have adopted code 96161 for screening for postpartum depression at well-baby visits (some may allow up to six screenings before the child is 13 months old). Code 96127 is also applicable to assessments for conditions such as anxiety, attention-deficit disorders, and generalized psychosocial symptoms (e.g., pediatric symptom checklist).

CPT Code 96160: Health Risk Assessment

Medicaid plans often allow payment for adolescent HRAs using tools such as the HEE-ADSSS (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety) assessment or the CRAFFT (Care, Relax, Alone, Forget, Friends, Trouble) screening tool. For example, Texas Health Steps pays for adolescent mental health screening using specified structured instruments reported with code 96160 when completed by the patient, and 96161 when completed by a caregiver. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. For instance, one plan in Tennessee has paid between $150 and $250 for code 96160 when a specific HRA is completed in conjunction with the IPPE or AWV.

Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. In addition, most are recommended preventive services, and some may also be factored into performance ratings and quality initiatives. If you are not sure about how to bill them, we can assist you. Medisys Data Solutions Inc. is a leading medical billing company that is well versed with billing policies and guidelines for Medicare. If you need any assistance in podiatry medical billing, contact us at 302-261-9187

*CPT is a registered trademark of the American Medical Association (AMA)

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