CPT 96127 is defined as a “Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), with scoring and documentation, per standardized instrument.” 1 In practice, it is used whenever a clinician or care team administers a validated mental health questionnaire (such as the PHQ-9, GAD-7, suicide-risk screen, substance-use screen, ADHD or autism screen, etc.), scores it, and records the result. The ACA’s mental-health parity mandate specifically encouraged use of 96127 for routine depression and anxiety screens. 2 3 It applies in any outpatient setting (primary care, behavioral health clinic, employee health) where such a tool is given – often during well-visits or new-patient screenings. For example, many practices use 96127 to bill when patients complete PHQ-9 or GAD-7 forms, or when adolescents take RAAPS/CRAFFT substance-abuse screens. The code does not denote time (no minimum minutes) – it covers the entire administration, scoring and documentation of one instrument.
Qualified clinicians (with billing NPI) can report 96127. This typically includes physicians (MD/DO), psychiatrists, psychologists, nurse practitioners, physician assistants, and other licensed providers who are authorized by payers to bill behavioral health codes. 4 For example, a primary care MD, pediatric NP, or psychologist may bill it. Non-clinical staff (e.g. medical assistants or nurses) can administer the screen, but cannot bill; a supervising provider must incorporate the results into the patient’s record. 2 Some billing guides note that 96127 is not reported by therapists (LPCs, LCSWs) under their therapy CPTs 4 – largely because psychotherapy codes already include ongoing clinical assessment. However, clinical social workers or counselors may bill 96127 if state/payer rules allow, provided they have a qualifying license and it is not being billed redundantly with a psychotherapy session.
Settings: 96127 is used in primary care clinics, psychiatry and counseling offices, community clinics, and any behavioral health setting where assessments are done. It is often part of an intake or follow-up visit. For example, 96127 is appropriate during preventive care exams, chronic care visits, or psychiatric evaluations when a standard questionnaire is given. 2 It can also be used in group settings if appropriate.
Time: There is no CPT-defined time threshold; the code covers the brief screen from start to finish. In practice, most questionnaires take only a few minutes (e.g. PHQ-9 ~2–5 minutes). The key is that a standardized instrument is used, scored, and documented.
Documentation: Proper charting is essential. Documentation should record the date, patient name/ID, the name of the instrument, the score (raw and/or interpretation), and the identity and credentials of the person administering it. 5 A physician or qualified provider must note review of the results in the progress note or E/M record. For example, include a statement like “PHQ-9 administered with score X, reviewed and discussed by MD.” If follow-up actions or referrals are triggered by the result, those plans should be noted as part of the medical record. (Some payers may require a brief report if the screening is positive, though often the score in the note suffices.)
Frequency: CPT 96127 itself imposes no limit on the number of times it can be used per patient or per day. In fact, it can be reported for each instrument given. For example, a patient completing both a depression and an anxiety questionnaire could yield two units of 96127 on the same date (see Modifier rules below). One source notes it can be billed “for up to four different screeners per patient per visit”. However, actual payer limits vary. Many insurers do not pay 96127 more than once per day or per visit, and some limit it per year. Medicare Part B specifically only covers one annual depression screen (via HCPCS G0444) 3 – 96127 is not separately reimbursed for routine annual depression screening in Medicare (see next section). Other commercial or Medicaid plans may allow repeated use if clinically indicated (e.g. initial visit + follow-up visits), but practices should verify each payer’s policy.
General Billing: Report 96127 in addition to any Evaluation & Management (E/M) or other service when a distinct screening is performed. When billing 96127 on the same day as an E/M visit, attach modifier 25 to the E/M code to indicate a separate service. (The E/M is billed with regular evaluation codes [e.g. 99213-99215, 99385-99395, etc.], plus 96127 on a separate line.) If multiple different instruments are given, bill multiple units of 96127 with modifier 59 (or XE/XS/XU) on the extra units to distinguish them as separate services. For example, if both a PHQ-9 and a GAD-7 are administered, you might report “96127, 96127” with the second unit flagged (59) to avoid bundling edits. 6 3
Medicare Part B: Traditional Medicare does not cover routine screening tests like 96127 under its standard NCD (42 CFR §410.33). Instead, Medicare covers one annual depression screening in the primary care setting via HCPCS G0444 (up to 15 minutes using PHQ-9 or similar). Thus for Medicare patients, if performing an annual depression screen on an asymptomatic patient, use G0444 (with diagnosis Z13.31 or Z13.89) instead of CPT 96127. Only if symptoms are already present (e.g. patient complains of depression) can you use 96127. 3 Even then, many Medicare contractors see 96127 as a screening tool and may bundle it into the visit; one guidance notes that if the screening “does not require an interpretation and report,” Medicare often will not pay it separately. 6 Medicare Advantage plans may have more flexibility, but it’s safest to follow the FFS rules (G0444).
Commercial Insurers: Most major commercial payers do cover 96127 (the code was created to support ACA-mandated screening benefits). 2 For example, patient education materials note that Aetna, Cigna, United, and others reimburse 96127. Coverage policies differ widely: some allow 96127 at every visit if needed, others limit it to annual or specific well visits. Always check the payer’s policy. Many payers follow general CPT guidelines: pay up to one unit per patient per day (unless multiple tests, see above), require proper CPT/ICD coding (e.g. Z13.89 “encounter for screening for other disorder” 3 or relevant mental health diagnoses), and may require that the results be documented in the chart. Several carriers follow the AAFP advice to append modifier 25 to the E/M on the same day. 6 If the screen was a preventive service, some plans allow modifier 33 on the service.
Medicaid and State Plans: Many Medicaid programs cover 96127, but rules can vary by state. Under EPSDT (pediatric wellness), behavioral health screens are usually covered. Some states encourage using specific tools (e.g. the Columbia Suicide Screen or CRAFFT) and will reimburse 96127 when used. For adolescent patients, Medicaid may cover annual behavioral health assessments as part of well-child care. Note that for caregiver risk assessment (e.g. maternal depression screening during a child’s visit), CPT 96161 (caregiver assessment) exists 3 and is billed under the child’s chart. In short, confirm with state Medicaid manuals: some payers bundle 96127 into cap payments or have unique codes (e.g. HEDIS screenings), while others pay it like a normal procedural code.
96127 is explicitly included as a covered telehealth service. Medicare’s telehealth list (PFS) shows 96127 as CMS-covered. 1 EmblemHealth’s policy likewise indicates 96127 is payable via telemedicine (listed as a permanent telehealth service). 8 Therefore, practitioners can administer and bill 96127 over a live, interactive video visit. In billing, use the same rules as for other telehealth: typically append modifier 95 (or GT) and report Place of Service “02” (or “10” if the patient is at home) as required by Medicare and most insurers. (Since 2021, CMS allows using the office POS with modifier 95 as an alternative for Medicare.) Audio-only (telephone) encounters are generally not acceptable for 96127, because video interaction is expected for a “telehealth” service. Most commercial insurers follow parity laws and reimburse video-based 96127 at the same rate as in-person (where they cover it at all). Always confirm with each payer’s telehealth policy, but in practice 96127 is treated like any telehealth E/M.
With E/M Services (992xx, 993xx): 96127 is often done in conjunction with a medical or psychiatric evaluation. It is reportable in addition to an E/M visit when the screening is a separate, measurable service. As noted, append modifier 25 to the E/M code when both are billed on the same day. The E/M note should mention the screening (date, result) and any plan of care changes. Medicare and insurers expect the provider’s interpretation/discussion to be part of the E/M note – the 96127 line covers only the administration of the tool. 6 5
With Psychiatric Evaluation (90791/90792): These diagnostic interviews include mental status assessment and history. Many payers consider the use of 96127 redundant when 90791 is billed, unless the provider did a formal standardized screen in addition to the interview. If the clinician separately gave a validated questionnaire beyond the usual evaluation, some payers may allow 96127 as extra, but often it’s bundled. Check policy: if a payer argues that the standardized screening is “included” in a comprehensive psychiatric intake, then 96127 would not be paid.
With Psychotherapy (90832/90834/90837 or 90833/90836/90838): Routine therapy sessions entail ongoing clinical assessment. Most plans will consider 96127 part of the psychotherapy session (or at least included in it) and not reimburse it separately on the same date as individual psychotherapy. In other words, you typically do not bill 96127 during a 908xx therapy visit, since those CPTs already imply assessment of patient status. An exception: if the screening was done by non-therapist staff and you want to document it distinctly, some practices still report it, but be aware many payers will deny the extra charge. Always verify whether 96127 is allowed with therapy codes for your payer – many will not pay it in that context.
With Preventive Visits: If a 96127 screen is done during a Medicare Annual Wellness Visit (AWV) or IPPE, note that AWVs bundle many services. Medicare does not pay 96127 separately if it was “required” as part of the AWV; instead, the AWV already includes standardized cognitive/behavioral questions. For other insurers, it’s common to bill 96127 on the day of a preventive exam or well-child check as long as you document it as an additional service. (For a well-child exam, use the child’s well-visit code plus 96127, with diagnosis Z13.89 or a relevant mental health code.)
Other Codes: Do not use 96127 in lieu of developmental screening codes. For developmental milestones in young children use 96110–96113. For caregiver-focused risk assessments (e.g. maternal depression during pediatric visits) use 96161. 5 3 For depression screening in Medicare, remember to use G0444 instead of 96127.
While 96127 pays only modestly (typically around $4–$7 per screen 2), it carries outsized clinical and quality value. It provides a clear way to systematically assess mood and behavior, which can lead to earlier identification of depression, anxiety, substance use, or suicide risk. Practices that use 96127 find they can improve their compliance with screening guidelines and quality measures. For example, reporting 96127 (with proper diagnosis and documentation) helps fulfill HEDIS or MIPS depression-screening measures. As one expert notes, failing to bill for these screens may mean “leaving money on the table,” since payers often incentivize recommended behavioral screenings. 6 In fact, some practices earn extra payment under pay-for-performance programs for meeting screening targets.
For patients, 96127-driven screening means that important symptoms are spotted even if the patient did not spontaneously report them. A brief questionnaire can catch silent depression or anxiety and ensure timely referral for treatment. It also engages patients by quantifying their symptoms over time. In sum, CPT 96127 enables providers to routinely monitor behavioral health without a lengthy testing battery. This aligns with the ACA’s goal to integrate mental health into regular care. 2 As an AAFP analysis puts it, structured screening services “may be beneficial to both the patient and the practice”. 6 When used correctly, 96127 supports patient care by adding objective data to the clinical picture, while also helping practices document and receive payment for these valuable preventive services.
Sources:
American Medical Association - Behavioral Health Coding Resource https://www.ama-assn.org/system/files/behavioral-health-coding-resource.pdf
Nevada Division of Public and Behavioral Health - CPT Code 96127 Overview https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Providers/CPT%20Code%2096127.pdf
Zero Suicide - EDC - Tips for Supporting Depression Screening https://zerosuicide.edc.org/sites/default/files/Identify%20Patients%20at%20RIsk%20for%20Suicide-Tips%20for%20Supporting%20Depression%20Screening.pdf
Connected Mind - CPT Code 96127 Frequently Asked Questions https://connectedmind.me/articles/billing-for-mental-health/2023/01/04/cpt-96127-frequently-asked-questions
American Academy of Family Physicians (AAFP) - Four Screening Codes You Should Be Using https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/screening_codes.html
AAFP - Getting Paid for Screening and Assessment Services https://www.aafp.org/pubs/fpm/issues/2017/1100/p25.html
American Medical Association - Telehealth Services Covered by Medicare and Included in CPT Code Set https://www.ama-assn.org/system/files/telehealth-services-covered-by-medicare-and-included-in-cpt-code-set.pdf
EmblemHealth - Reimbursement Policy: Telehealth and Virtual Care Services https://www.emblemhealth.com/content/dam/global/pdfs/provider/reimbursement-policies/Telehealth-Virtual-Care-Services.pdf
Centers for Medicare & Medicaid Services (CMS) - Billing and Coding: Psychological and Neuropsychological Testing (A57481) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57481
