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Wiki Denials for CPT code 96127

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emcneill

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Chandler, AZ
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Hello - We are seeing denials when billing for Behavioral Health 90837-95 and 96127. Is anyone else seeing this trend? I did read some articles that some payers require modifier 59, but was not able to find anything on the Aetna, Tricare and BCBS Ohio website.
 
Hi EmcNeill
The CPT code 96127 is for developmental screening for dx of ADHD,Beh emotions, Depression, but do not use for Cognitive or Aphasia. pg 725& 726 . Also Id use modifier 25 with CPT code 90837 not 59. Modifier 59 is more for surgery in differ places on body or types of surgical procedure during same time. Also CPT 96127 is resequencing to see CPT 96020-96121
Check that data out it might help. .Also you can take any CPT code to the CMS physician fee website to see which dx it matches too or more info too
Lady T
 
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