96127 and UHC

mariaher921

Contributor
Messages
13
Location
Richlands, NC
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Hello, we are able to get reimbursement from every major healthcare provider. We are at a loss with United healthcare though. I was wondering if I can get any feedback from somebody on how they get reimbursement for the 96127 CPT code. Not sure if it has something to do with the diagnosis or a missing modifier. This is how are usually bill it
99213 - 25
96127 - 33 (z13.31)
Thank you for any assistance
 

SharonCollachi

True Blue
Messages
1,201
Location
Clovis, CA
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3
Does UHC pay for anything mental-health related that is billed by a non-mental health provider? They may consider it included in the E&M visit, particularly if it is a patient self-test.
 
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355
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The UHC commercial plan payment policy for preventive services includes the following. (Medicaid plans are likely the same.) You can find more information at uhcprovider.com under the policies and protocols section.

Q: How does United Healthcare reimburse for screening tests based on a questionnaire completed by the patient or a family member when done in conjunction with a Preventive Medicine Service?
A: Counseling, anticipatory guidance and risk factor reduction interventions are integral to a preventive medicine visit. Historical information may be obtained either through direct questioning or through completion of a written questionnaire. The responses on a questionnaire often identify areas for more focused interventions or treatments. Since this screening is part of a Preventive Medicine Service, it is not reimbursed separately. Occasionally, a screening instrument requires interpretation, scoring, and the development of a report separate from the preventive medicine encounter. In those situations, where a CPT code exists for that service, screening, interpretation and development of a report is reimbursed separately from a Preventive Medicine Service.
 
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