Question Preventive Depression Screening CPT G0444 or 96127?

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1
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Edina, MN
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What is the difference between G0444 and 96127 for depression screening, and where does it indicate who can use it? Am I missing something in the coding description?

I work for an insurance company and am being instructed to setup G0444 to be allowed for depression screening for any diagnosis. That means if a provider bills G0444, regardless of diagnosis, G0444 will pay 100%, without assessing member's deductible or charging the member, as this is considered a preventive benefit.

I'm being asked to setup 96127 for depression screening requiring diagnosis Z13.32, which I understand, as 96127 seems to be pretty broad. If a provider bills 96127 with Z13.32, it would pay 100% per preventive care benefits.

This is where it gets confusing. I was also asked to setup 96127 for depression screening with diagnosis Z13.31, for only members under 21. That means if a provider bills 96127 with Z13.31 for an adult, the claim will pay less, and the member might get charged. It appears that the provider is supposed to know that for non-pregnant adults, they need to know to bill G0444. Can someone verify that this is true? We do not have a policy setup that mentions this, and aren't allowed to explain to providers what the correct code is when they call in to appeal denials. I am wondering if this criteria is standard and I am missing something, because I don't agree with the other coder's decision.

Thank you!
 

thomas7331

True Blue
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I suppose that insurance companies have a right to make their own decisions about what code combinations they will pay or not, but I agree with you that without a published policy, this is going to be very confusing for providers. G0444 is a screening service by the code definition, so for a provider to bill this code with any diagnosis other than a screening would suggest incorrect coding to me. 96127 is a diagnostic service, so a screening diagnosis would not make sense with this code. Some payers do allow screening benefits for diagnostic procedures, but that's often when there is no screening code available, or when the payer does not recognize a particular screening code. But if your company is accepting G0444, then I don't know why they'd also want to pay depression screening benefits under 96127 as well. I can't speak for your other coder's decision or rationale, however, and don't know the ins and outs of the plan benefits and how they are structured, so I don't think I can offer much help beyond this. But certainly, having dealt for years with insurance companies that make coding and payment decision behind closed doors and with no published policies, I do think it is a poor business practice and a bad way to treat providers, so I appreciate your sympathy with their plight!
 

jliving77

Networker
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Tucson, Arizona
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I have been doing a lot of research about this. I am confused.
G0444 appears to only be billable to Medicare. Correct?
Does G0444 need a modifier when billed with G0439? Is an ABN required? Doe time have to be documented by the provider (15 mins) or can the time spent by the patient completing a PHQ-9 questionnaire and the MA's time in entering it into the EMR for the provider to review count towards that time?
Does 96127 need a modifier? I have been adding 59. Is this billable to all other plans excluding Medicare?
Our practice just recently started billing for these services and I want to make sure we are doing this correctly. There are so many articles I have found but all only explain what the depression screening is and what needs to be documented in order to bill.
Help!
 
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Hi,
The best answer for this question can be find under Medicare link https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/Manuals/preventive services guide/depression screening - preventive services guide/!ut/p/z0/lVBNb8IwDP0r4dAjsvmaxDFiQ2wICWmXkssUWi8zFLckadn-_QLaYZMGEj75PdvPzwYDORixHTsbuRZbJbwxD29j_fw0GMxwifPlGPXr43Qx1NMRrhFewKQGvBIazwpDv5qtHJjGxo8-y3sNubhwoJIL6-lH4saO_yUaTx1J5I5UIN9xQUG5lkuCvKRUDCGdoELhiYTFqb66MQEb3h2PRoMpaon0Gf9YvHAShU4Z_qIvuGm3VULnf4UMD1ZaW6Xk6q4M73bX7M12Uu2-TrrX-wavYLqy/- for depression screening and https://www.medicare.gov/coverage/preventive-screening-services- for all preventive services.
G0444 is preventive service and can be done during G0439 (but not with G0438) or with other follow up office visits. This is NCD. But local Medicare Administrative Contractor can be to have some different policy. Contact with your local Medicare Administrative Contractor. G0444 can be billed for insurances which keeps Medicare policy for this service. All diagnostic codes are on the Medicare website.
Service 96127 is not a preventive service. It is can be billed by specialist only (regarding credentialing list).
 
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