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CPT Code 96127

Stephanie Posted Wed 06th of November, 2019 13:17:53 PM
Can a therapist and psychologist bill for this code in the state of Texas? Where would I be able to find who can bill a particular CPT Code
SuperCoder Answered Thu 07th of November, 2019 05:29:44 AM

Hi Stephanie,

 

Thanks for your question.

 

Medicare Physician Fee Schedule assigns fee of $5.41 to this code (96127), which indicates that this code should be reported and paid for screening and assessment services unless a payer’s written policy restricts payment. Medicare may pay this code in all states. If your payer is other than Medicare, then you need to determine which payers in your locality pay for these services.

 

Please feel free to write if you have any question.

 

Thanks.

 

Stephanie Posted Thu 07th of November, 2019 09:45:09 AM
This did not answer my question at all. My question is, can a psychologist or therapist bill this code.
SuperCoder Answered Fri 08th of November, 2019 07:23:06 AM

Yes, CPT code 96127 can be billed by therapist and psychologist. Per lay term descriptor, this code is billed by a provider. Provider can be a Psychologist as well, but it is not specific to Psychologist only. It can be billed by an MD as well. The code descriptor does not specify about billing under Psychologist or therapist ONLY.    

 

This code is related to assessment for ADHD, depression, suicidal risk, anxiety, substance abuse, eating disorders, etc., and it covers services such as depression screenings for adults and adolescents, alcohol misuse in adults, alcohol and drug use in adolescents, and behavioral assessments in children and adolescents which are the areas of concern of Psychologist. Hence it would be appropriate to bill this service under Psychologist even though the code descriptor does not specify about service being performed under Psychologist.         

 

There is no specific list which can provide us with “who can bill what” CPT codes.

 

To identify this, you need to get in touch with your payer to identify the rules, regulations and guidelines related to billing of CPT codes in your area.

 

Hope this helps.

 

Thanks.

 

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