96127 CPT code Coding guide for Coders

Basics of 96127 CPT code

Emotional/behavioral assessments may be performed by medical and mental health professionals in the clinical setting and also by trained professionals in the educational setting. These assessments gather information regarding feelings and emotions and problem behaviors through direct observation of the individual and/or questionnaires completed by the individual, caregivers, teachers, and others. CPT code 96127  is reported for such exams.

Areas assessed can include activities of daily living (ADL), relationships, attitude, adaptability, aggression, anxiety, attention, atypicality, conduct problems, depression, functional communication, hyperactivity, social skills, somatization, withdrawal, and self-esteem. Assessment tools may include the Behavior Assessment System for Children-Second Edition (BASC-2), Behavior Rating Profile-Second Edition (BRP-2), Child Behavior Checklist (CBCL), Conners Rating Scale, Pervasive Developmental Disorder Behavior Inventory (PDDBI), Brief Infant Toddler Social Emotional Assessment (BITSEA) and the Patient Health Questionnaire for Depression and Anxiety (PHQ-4, PHQ-9).

The individual tests can take from 10-45 minutes to complete with additional time allocated for the results to be compiled and scored. CPT code 96127 is reported for each standardized test that is administered, scored, and reported.

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Description of 96127 CPT code

96127 Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

Additional Code Information of 96127 CPT code

PC/TC Indicator (26):                       3 = Technical Component Only Codes
Multiple Procedures (51):                0 = No payment adjustment rules for multiple procedures apply
Bilateral Surgery (50):                      0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision:                      09 = Concept does not apply
Assistant Surgeon (80,82):               0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted
Co-Surgeons (62):                              0 = Co-surgeons not permitted for this procedure
Team Surgery (66):                           0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family:           99 = Concept does not apply

 

RVU and Fees for 96127 CPT code

Non-FacilityWorkMPPERVUTotal
0.000.010.130.14$4.74
FacilityWorkMPPERVUTotal
0.000.010.130.14N/A

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