What is CPT code 96127 and its reimbursement requirements?

CPT code 96127 is a billing code used for conducting brief emotional and behavioral assessments performed with standardized instruments. CPT 96127 may be used for administering screenings, such as the Patient Health Questionnaire (PHQ-9).

This code is fairly versatile, as you can use it:

• With adults, children, and adolescents.
• For patients already being treated for mental illness.
• For patients with complex medical issues.
• At any point during care, including post-hospitalization or new diagnoses.
• With most major insurance providers, including Medicare.
• When administered by a qualified healthcare professional, not just psychiatrists.
• With multiple assessments — up to four — per session.

Of course, some payers may have specific requirements for reimbursing this code, but for the most part, this is a broad code offering more billing opportunities for mental health providers and other clinicians. It functions as a CPT code for anxiety screening, depression scales, substance abuse testing, and many other screens.

Providers utilizing the questionnaires included in the Creyos product may be eligible for reimbursement through CPT code 96127, described as the following by the Centre for Medicare and Medicaid Services (CMS): Brief emotional/behavioral assessment, with scoring and documentation, per standardized instrument.

As per the latest guidelines from the American Medical Association, this code is also telehealth-approved. Usage limits and reimbursement amounts vary by state, payer types, and potentially other factors, though the average reimbursement value can range anywhere from $4–$8. When administering the questionnaires alongside other mental health screening instruments, such as the PHQ-9, you may be able to report one unit for each questionnaire completed. For further information, please contact your local payer.

Please note: Creyos cannot determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. The CPT code(s) noted below to report the services provided will depend on other procedures performed, associated CCI edits, and other factors. Please contact your local payer to determine whether you qualify for these codes, and if any additional coding and coverage guidelines exist, such as which providers can perform the service, limits on billable time, or if the use of a modifier is required or allowed.