Wiki 96127 Denials

[emcneill]

Currently see a denial trend for CPT code 96127 (Aetna, Tricare and BCBS Idaho). We billed 90837-95 and 96127 and are receiving denials. I did read some articles that some payers require the 59 modifier w/96127. Does anyone else know about this CPT code and the requirements? Or having the same denial trend. Thank you!

 

[istanstu]

I think there is an update that CPT code max units and non use of telehealth mod is out there somewhere

 

[NCarrollC]

Does anyone know the guideline in billing 96127. Patient comes in for a routine exam and a PHQ-2 is filled out for a depression screening and attached to the medical record. The Medical Assistant puts the score in the note. Modifier 25 is put on the E&M and screening diagnosis used. For 96127 depression screening is used. Does this sound correct. Thank You

 

[HayleeO]

Does anyone know the guideline in billing 96127. Patient comes in for a routine exam and a PHQ-2 is filled out for a depression screening and attached to the medical record. The Medical Assistant puts the score in the note. Modifier 25 is put on the E&M and screening diagnosis used. For 96127 depression screening is used. Does this sound correct. Thank You

This is the exact same question I was going to ask! this is how our providers are also doing it.

 

[MargoR]

Good morning, isn't the behavioral testing (96127) part of the psychotherapy service?

What is the denial reason?

 

[jkyles]

Hi there, MargoR is correct - the test code is bundled into the psychotherapy service. In addition, the edit can't be broken with a modifier.

Remember to research the remittance advice codes and check bundling edits. If possible, check the edits before you submit claims.