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Reimbursement for BH Screening
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11/13/2019 at 6:00:09 PM GMT
Posts: 32
Reimbursement for BH Screening

Hello All,

Could others speak to any codes/strategies they’re using to get reimbursed  for BH screeners? We get reimbursed for the PHQ-2 once per year per patient  using the depression screening G codes, but I’m wondering what else is  out there. I’ve recently set my practicum student up w/ a small project in which she spends a few minutes w/ new adult patients establishing care. She orients them to the BHC’s role in their care, and then does the PHQ-2, GAD-2, CAGE,  & 1-item ACEs (we will probably expand the list if it goes well). If anything flags, she offers a BHC visit. If the patient agrees, business as usual. If they decline, she provides a handout on the flagged issue, encourages the patient to reach out as needed, & debriefs the PCP. (Of course, if there is any indication of safety concerns we will address that either way.) I imagine many of you do something similar. We didn’t go into this w/ reimbursement in mind, but a recent training I went to sparked the idea. So far I’m seeing 96127 – looks like it might work at least some of the time. I’ve also come across 99420 as a possibility? Anyway – just wondering if those more knowledgeable than I could speak to whether there's a code likely to work for this, or if we should just be happy w/ the direct clinical & other indirect benefits! Thanks for any thoughts. Looking forward to seeing/meeting many of you in Denver soon!


Hello Mike, Our clinic uses a few different codes with variable success. 96127 Seems to work sometimes for anxiety, depression, and behavioral screeners. 96110 for developmental screeners, and 96161  may work for postpartum depression screeners when the patient is the child. One thing to watch out for is patients ending up with co-pays for the screening tools if you're billing for them. Some patients may then end up declining being screened. Best, Jessica

To Jessica's point, our system has discontinued charges for BH screening  (PHQ/GAD) as patients would refuse re-screens (due to cost) and this left  them on our depression registries without a pathway to determine improvement.  It was also negatively impacting our integrated BH efforts.  We have tried  to conceptualize the screeners as part of the bundled visit to primary care  in the same way that we don't charge a la carte for taking your blood  pressure, weighing you, taking your temp, etc.


Thanks for the thoughts Jessica & Jeff. We definitely don't want patients getting charged for this, so that will be the #1 thing for me to look into. We want to deepen our integration & increase attention to our population at large, which will of course involve a number of worthwhile benefits even if we can't directly collect on it. If others have additional thoughts I'm definitely up for learning all I can about this!


I think Jessica got the codes correct.  For all billing and screening codes, if your are in a primary care clinic, usually if the codes for screening are billed to the primary care provider they get paid.  If the mental health provider bills along with a bill for a dx or therapy session sometimes the screener codes don't get paid.  I would recommend billing  by the PCP.


Yes. My understanding is that the reimbursement is technically for the  physician's time interpreting/addressing the scores of the screen with the  patient and not for the administration of the screen (which can be done by  a variety of people, not necessarily licensed behavioral health).


Last edited Wednesday, November 13, 2019

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