All Medicare beneficiaries who are both: Not within 12 months after the effective date of their first Medicare Part B coverage . Four codes are used to report structured screening and assessments: 96110, Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument,, 96127, Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument,, 96160, Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument,, 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.. Another option is to use the Download button at the top right of the document view pages (for certain document types). Separate billing for scoring and report preparation is not allowed. The effective date of this . But you can quickly learn to use screening and assessment codes effectively and accurately. If your session expires, you will lose all items in your basket and any active searches. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or 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. The patient is reluctant to take any medication due to her addiction. End User License Agreement: Was your Medicare claim denied? If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Clarification was made to the Health and behavioral assessment and Health and behavioral intervention. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. However, some payers may reimburse for this service. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. All rights reserved. A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits. Revision Number: 1 Publication: December 2019 Connection LCR B2020-001. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Coding Alert 1: Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings, Hughes notes. The AMA assumes no liability for data contained or not contained herein. If you are not billing for these services, you may be losing out on valuable revenue. National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits do not bundle 96160 and 96161 into the office/outpatient evaluation and management (E/M) codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient ) or the preventive medicine E/M codes 99381-99396 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/established patient ), and no CPT regulations prohibit the services from being reported together. Because of the impact on the medical management of the patients disease, documentation must show evidence of coordination of care with the patients primary medical care provider or medical provider responsible for the medical management of the physical illness that the psychological assessment/intervention was meant to address. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, presented in the material do not necessarily represent the views of the AHA. This procedure includes the administration of the questionnaire, documentation, and scoring. The document is broken into multiple sections. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. required field. The contractor information can be found at the top of the document in the, Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. CPT codes 96150 - 96154 are to be billed as one service for each 15 minute of face-to-face contact with the beneficiary(s). Copyright 2023 American Academy of Family Physicians. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). The AMA does not directly or indirectly practice medicine or dispense medical services. Review the article, in particular the Coding Information section. CMS believes that the Internet is For additional quantities, please contact [emailprotected] 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. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. No fee schedules, basic unit, relative values or related listings are included in CPT. CPT code 96160 can be used for every standardized survey questionnaire if the criteria are established and agreed upon by experts). CPT 96127: This code is used for the administration of a brief emotional/behavioral assessment with scoring and documentation. A patient with a family history of osteoporosis completes a bone health risk assessment instrument. You can collapse such groups by clicking on the group header to make navigation easier. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. A score is assigned to the patients health risk based on the assessment instruments criteria. If that doesnt work please contact, Technical issues include things such as a link is broken, a report fails to run, a page is not displaying correctly, a search is taking an unexpectedly long time to complete. Coding Alert 1: Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings, Hughes notes. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Heres your chance to prove you know your way around the F01-F99 codes. See the CMS . Several CPT codes will be permitted through audioonly telehealth after 5/11/2023. However, code 96127 should be reported for both screening and follow-up of. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). s an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. 2. A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. Code 96161, on the other hand, assesses a caregiver for the patient, not the patient him/herself, when the caregiver may have a condition that is affecting the patient. End Users do not act for or on behalf of the CMS. However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. For more information, visit Getting Paid for Screening and Assessment Services at www.aafp.org/fpm/2017/1100/fpm20171100p25.pdf and A Framework for Patient-Centered Health Risk Assessments at www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf. A healthcare provider administers a skin cancer risk assessment questionnaire to a patient with a history of sunburns and tanning bed use. Child Development/Developmental Monitoring and Screening. Use of structured instruments for assessing attention deficit should be linked to the ICD-10 code for the diagnosis or symptoms that prompted the assessment. Coding Guidelines Do not reportCPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 in addition to codes for psychiatry services on the same date. Please contact the Medicare Administrative Contractor (MAC) who owns the document. All Rights Reserved. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). It is the providers responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. . Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). Depression screening is not separately reported in conjunction with a Medicare initial preventive physical examination (IPPE, Welcome to Medicare exam) or an initial Medicare annual wellness visit (AWV). Report the additional CPT code (99202-99205 and 99211-99215) with modifier -25. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. Many payers and clearinghouses offer code edit simulators for use in determining whether codes for services such as screenings and assessments are bundled or separately paid. In most cases, modifiers will override the edits when clinically appropriate. The purpose of the screening or assessment should guide code selection. It begins with a listing of transition-related CPT codes and corresponding Medicare fees and relative value units (RVUs), effective as of 2022. . Medicaid reimburses providers for CPT code 96160 to a maximum of two units per visit. Your MCD session is currently set to expire in 5 minutes due to inactivity. CPT is a trademark of the American Medical Association (AMA). Several scenarios require use of a modifier when billing for screening and assessment services, including the following: Modifier 25 may be required to indicate a significant, separately identifiable preventive or other E/M service was provided on the same date. The submitted CPT/HCPCS code must describe the service performed.