Reimbursement -


1. Commercial Insurance Reimbursement for Brief Screenings

A recently released new CPT code, 96127 applicable to commercial insurance, enables PCPs and behavioral clinicians to conduct brief automated screenings of patients to assess for common behavioral conditions, e.g. depresssion, anxiety, substance abuse, suicidality, ADHD, eating disorders, etc.

Up to 4 brief screenings can be conducted in one assessment and payment averages about $6 per assessment. Thus clinicians can earn about $24 per patient screened. Screenings can be conducted up to four times a year per patient.

The code was created as part of the Affordable Care Act’s (ACA) mandate to include mental health services as part of ACAs essential benefit package in all insurance plans.

Significantly, the code does not require professional staff involvement in administration, scoring or documentation. In other words, clinicians can use the Precision Guided Behavioral Care (PGBC) mobile app for this purpose. Practices can use PGBC on a tablet in the office or via mobile device.

Since this code is new, there has not been much written about clinician’s experience with it. It is known that the Affordable Care Act requires that PCPs be be reimbursed for its use. It is not clear whether this holds true for behavioral clinicians. However, anecdotal evidence from clinicians around the country indicates that some behavioral clinicians are using the code successfully.

2. Medicare and Medicaid Reimbursement for Brief Screenings and Monitoring

The new MACRA program (for Medicare and Medicaid) incents clinicians to screen for depression and to monitor patients on antidepressant medication for adherence. Both tasks can be automated with PGBC.