CPT Code 96127: Behavioral Assessment Billing Guide +Reimbursement Rates

cpt code 96127Learn how to bill CPT Code 96127 for a brief behavioral assessment with scoring and find out what 96127 reimbursement rates in 2022 are for qualified healthcare professionals.  You’ll discover 96127 requirements for billing, time length, and scoring instruments.

If you would rather recreate Tom Hanks in Survivor than do your own billing, consider working with our mental health billing service.  Otherwise, enjoy our guide to behavioral assessment billing.

CPT Code 96127 Description

96127 Definition:  Brief emotional/behavioral assessment (e.g., depression inventory, eating disorders, suicide risk, anxiety, substance abuse, attention-deficit/hyperactivity disorder [ADHD] scale) with scoring and documentation, per standardized instrument.

Standardized instruments of scoring and documentation for CPT Code 96127 may include:

  • Ages and Stages Questionnaire: Social-Emotional (ASQ:SE)
  • Australian Scale for Asperger’s Syndrome (ASAS)
  • Beck Youth Inventories – Second Edition (BYI-II)
  • Behavior Assessment Scale for Children – Second Edition (BASC-2)
  • Behavioral Rating Inventory of Executive Function (BRIEF)
  • Brief Infant and Toddler Social Emotional Assessment (BITSEA)
  • Connor’s Rating Scale
  • Kutcher Adolescent Depression Scale
  • Patient Health Questionnaire (PHQ-2 or PHQ-9)
  • Pediatric Symptom Checklist (PSC)
  • Pediatric Symptom Checklist – Youth Report (Y-PSC)
  • Screen for Child Anxiety Related Disorders (SCARED)
  • Strength and Difficulties Questionnaire (SDQ)
  • Substance Abuse and Alcohol Abuse Screening (CRAFFT)
  • Vanderbilt Rating Scales
  • General Anxiety Disorder scale (GAD-7)
  • Depression Anxiety Stress Scales-with 4point Likert-type scale (DASS-21)
  • Alcohol Use Disorders Identification Test (AUDIT)
  • Beck Depression Inventory (BDI)
  • Columbia-Suicide Severity Rating Scale (C-SSRS)
  • Drug Abuse Screening Test (DAST-10)
  • Geriatric Depression Scale (GDS)
  • Life Event Checklist (LEC)

(Source) (Source) (Source)

cpt code 96127 reimbursement rate96127 Reimbursement Rate (Medicare, 2022):  $5.29

(Source)

96127 Time Length

There is no designated time length for CPT code 96127.  Each assessment and subsequent scoring will vary in length.  (Source)  As noted in the description of this procedure code, these assessments are often brief with multiple units (up to 4 per session) being used per visit.

CPT Code 96127 Requirements

The assessment must be provided and scored by trained administrative staff, MD, technician, computer, or qualified health professional (QHP).

For Psychological, or Neuropsychological testing that spans more than one day, you will use the last day of service with a quantity of 1.

cpt code 96127 descriptionMedical records need specific tests performed, mental illness symptoms, number of hours testing, test results interpretation, report time-based, psychological testing evaluation, administration and scoring services.  (Source)

There may be up to four scoring inventories performed per client per visit (maximum 4 units per day).  (Source)

The clinician must provide a distinguishing document between screening and assessment.  (Source)

Sources:  (1) (2) (3) (4) (5) (6) (7)

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