Billing Guide for Psychological Screening & Testing
Screening: This can be done in different ways: computer-based screening, physician interviews during the exam, or paper-based instruments.
| 96127 | Brief emotional/behavioral assessment with scoring and documentation per standardized instrument. |
Average Medicare allowable of $4.65 Per MC - additional screens are added to the unit lines and should not be billed as the same date of service as CPT 96130-96146 |
Major Medical: Most insurance companies cover 961127 for mental health screening. ICD10 Coding: Most insurance accept the generic screening code if the results are negative and either z13.xx or codes beginning with F if the results are positive. |
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Sample Documentation: Mental Health Screening As part of their intake evaluation, the patient was screened for depression, anxiety, ADHD, substance use disorder, bipolar disorder, and somatic symptom disorder. Screening results were negative for all conditions. |
- Testing Administered Codes: Upon establishing the potential for a mental health condition, testing is used to confirm its presence. Test administration for billing requires medical necessity and a related ICD-10 code. It can be performed by a physician, qualified healthcare professional, or a supervised technician using the specified method for each code.
| 96136 | Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method, first 30 minutes. Note: For each additional 30 minutes, use CPT code 96137. |
Average Medicare allowable of $41.89 * | |||||
| 96138 | Psychological or neuropsychological test administration and scoring by a technician, two or more tests, any method; first 30 minutes. Note: For each additional 30 minutes, use CPT code 96139. |
Average Medicare allowable of $34.48 * | |||||
| 96146 | Psychological or neuropsychological test administration, with a single automated instrument via an electronic platform, with automated results only. | Average Medicare allowable of $2.30 * *MC requires mental health-related ICD10 codes (generally beginning in F) |
Billing Guide for Psychological Screening & Testing
Screening: This can be done in different ways: computer-based screening, physician interviews during the exam, or paper-based instruments.
Major Medical: Depending on the mental health coverage of a patient’s insurance, there are 2 approaches for choosing ICD-10 codes ICD10 Coding:
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96138 Documentation: Mental Health Testing The patient presented with symptoms associated with a range of mental health conditions. A mental health screening was administered to evaluate these symptoms further. Screening results indicated the need to evaluate further [depression, anxiety, ADHD, substance use disorder, bipolar disorder, somatic symptom disorder]. Consequently, Validated Standardized Assessments were administered and scored by a technician using a computerized interview tool, along with verbal confirmation, following standardized criteria. The patient's cognition was not impaired, and the patient could participate in testing in a meaningful way. Administration and scoring of the Validated Standardized Assessments took a total time of [List total time of 16 - 30 minutes] minutes. [Input OutcomeMD Q&A/Scoring] |
Test Evaluation Codes:
| 96130 | Psychological testing evaluation services by a physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s), or caregiver(s), when performed; first hour. Note: For each additional one hour, use CPT code 96131. |
Average Medicare allowable of $120.50 * *MC requires mental health-related ICD10 codes (generally beginning in F) |
Major Medical: Depending on the mental health coverage of a patient’s insurance, there are 2 approaches for choosing ICD-10 codes ICD10 Coding:
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Documentation: Mental Health Report and Interpretation On consolidation and review of the results of Validated Standardized Assessments administered by a technician, along with verbal confirmation, I have determined that the patient meets diagnostic criteria for [depression, anxiety, ADHD, substance use disorder, bipolar disorder, somatic symptom disorder] |
Billing Guide for Psychological Screening & Testing
Screening: This can be done in different ways: computer-based screening, physician interviews during the exam, or paper-based instruments.
| Testing noted [with | without suicidal ideation]. See report for assessment report scores and severity of illness. Condition(s) have the potential to cause complications with the patient's chronic medical problems listed in the patient's current problem list and may also interfere with compliance with medical / medicine / preventive health recommendations. The assessment results and diagnosis(diagnoses) were discussed with the patient, and the patient was given an opportunity for interactive feedback. The patient agreed to the treatment plan listed in the plan section of today's encounter. The total time for assessment consolidation and review was [List total time of 31 - 60 minutes] minutes. [Input OutcomeMD Q&A/Scoring] |
Modifiers: The following modifiers should be used together when billing all mental health codes. Failing to use modifiers correctly WILL result in a denial of your claim in most situations.
| Modifier 25 | Must be present on the E&M code and the E&M code must be first on the CMS form. | |
| Modifier 59 | Must be present on the Mental Health code and the Mental Health code must be used after the E&M code on the CMS form. |
Additional Billable Codes: These codes cover Medicare and Medicaid annual wellness visits & Annual substance use counseling
G0442 - Medicare H0049 - Medicaid |
Alcohol and/or substance use (other than tobacco) screening and brief intervention services, 15 minutes. Note: It may be used up to once per year |
Average Medicare allowable of $19.09 |
| G codes for Medicare | G0444 Annual depression screening (see 96127 for use outside of the Medicare annual wellness visit) | Average Medicare allowable of $19.09 |
NCCI Guidelines: National Correct Coding Initiative
| NCCI - 2024 | If reported on the same date of service, the psychiatric diagnostic interview examination (CPT codes 90791, 90792), psychological/neuropsychological testing (CPT codes 96136-96146), and psychological/neuropsychological evaluation services (CPT codes 96130-96133) should be distinct. Physicians can include other clinical data in the report for CPT codes 96130-96133. Providers should not report time for duplicating information included in the psychiatric diagnostic interview examination and/or psychological/neuropsychological evaluation services or test administration and scoring for timed procedures described by CPT codes 96130-96139. |
Billing Guide for Psychological Screening & Testing
Screening: This can be done in different ways: computer-based screening, physician interviews during the exam, or paper-based instruments.
Additional Notes:
- 96127 should not be charged when billing for 96130, 96136, 96138, or 96146.
- 96136 OR 96138 can be billed with 96130 as long as the time for each service is counted separately.
- If complexity is used to calculate your E&M code, then the services performed for 96130, 96136, or 96138 cannot be counted during the E&M complexity calculation.
- 96130 is time-based and must include documentation showing that it took at least 31 minutes.
- If the total time with the patient consolidating information and writing a report was at least 91 minutes, then 96131 may be billed after the 96130 for an additional $86.19.
- If time is used to calculate your E&M code, then the time spent performing services for 96130, 96136, or 96138 must be separate.
- 96136 and 96138 are time-based and must include documentation that they took at least 16 minutes.
- If the total time spent administering tests and interviewing the patient was at least 46 minutes, then 96137 or 96139 may be billed after 96136 or 96138 for an additional $37.90 or $35.49.
- Ensure that the ICD-10 codes used to justify the E&M are different from those used to justify 96127, 96130, 96136, 96138, or 96146, otherwise, those codes will be bundled with the E&M and not paid separately.
- When determining if time was met for a timed code, you must have at least half of the code time plus one minute. For example, a 30-minute code like 96136 or 96138 would require at least 16 minutes of total time to administer a test, confirm answers, etc., to count.
Psychiatrists Only:
- You cannot bill 90792 along with 96130, 96136, or 96138. However, you can bill an E&M code along with 96130, 96136, and/or 96138.
- Make sure the ICD-10 codes for E&M are not used for 96130, 96136, or 96138. Clearly distinguish between E&M and 96130, 96136, and/or 96138 in your visit note.
Therapists Only:
- Therapists cannot bill any codes on this billing guide - please see the Mental Health CPT help guide.
- 90791 is the code designed to cover psychological screening, testing, and evaluation services
General Limitations: The following are considered not medically reasonable:
- Regular re-evaluation of chronically disabled patients not necessary for diagnosis or treatment is not medically reasonable. Additionally, brief screening measures
Billing Guide for Psychological Screening & Testing
Screening: This can be done in different ways: computer-based screening, physician interviews during the exam, or paper-based instruments.
- Like the Folstein Mini-Mental Status Exam should not be billed separately as psychological or neuropsychological testing, as they are typically part of a broader clinical exam.
*OutcomeMD does not support billing.