If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. During the PHE, outpatient psychiatric service facetoface requirements were waived. Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. LCD - Health and Behavior Assessment/Intervention (L33834) End User License Agreement: All Rights Reserved (or such other date of publication of CPT). In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Copyright 2017 by the American Academy of Family Physicians. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Code96146, Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only, should be reported once per session (CPT Assistant, October 2018). PDF Coding for Standardized Assessment, Screening and Testing To support a claim for CPT 96160, the following information should be documented in the patients medical record: When billing for CPT code 96160, it is important to remember that the code includes the administration of the standardized questionnaire, scoring, and documentation. How Do 96160/96161 Differ From Other Screening and Assessment Codes? Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Specifically, CPT code 96160 describes the administration of patient-focused health risk assessment instruments with scoring and documentation, per standardized instrument. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Look for a Billing and Coding Article in the results and open it. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. Compliance with the provisions in LCD L33834, Health and Behavior Assessment/Intervention may be monitored and addressed through post payment data analysis and subsequent medical review audits. The healthcare provider selects an appropriate standardized health risk assessment instrument for the patient. All Rights Reserved. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM). Both 96110 and 96127 reside in the central nervous system assessments/tests code group (96105-96146) and are used to report the services provided during testing of the central nervous system functions, per CPT. PDF Quick Reference for Social Determinants of Health (SDOH) Coding If you would like to extend your session, you may select the Continue Button. CPT 96150: This code is used for an initial health and behavior assessment conducted by a healthcare professional. When using Edinburgh Postnatal Depression Screening to screen for depression in pregnant or postpartum patients, it is more appropriate to report CPT code 96160, Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument. This Agreement will terminate upon notice if you violate its terms. This is based on CPT guidance for central nervous system assessments that states, It is expected that the administration of these tests will generate material that will be formulated into a report. Verify your payers' documentation requirements prior to providing these services. A healthcare provider administers a mental health risk assessment questionnaire to a patient experiencing high levels of stress. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). For example, Texas Health Steps pays for adolescent mental health screening using specified structured instruments reported with code 96160 when completed by the patient, and 96161 when completed by a caregiver. Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. CPT code 96150 : Health and behavior initial assessment, each 15 minutes face-to-face with the patient CPT code 96151 : Health and behavior re-assessment, each 15 minutes face-to-face with the patient Deleted H&B Assessment Services (Effective 1/1/2020) 6 The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This code is used when a healthcare provider administers a standardized questionnaire to a patient to help identify specific health risks, analyzes the results, assigns a score, and documents the findings. Payer guidance for reporting postpartum depression screening also varies. Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. 96161 is to be reported to the patient's health plan as it is a service for the benefit of the patient. CDT is a trademark of the ADA. Screening and assessment services should be reported unless a payer's written policy restricts doing so. Per CPT, standardized instruments are validated tests that are administered and scored in a consistent or standard manner consistent with their validation. For 96160, that would include such tests as the Mini Nutritional Assessment-Short Form; Sport Concussion Assessment Tool (SCAT 5-); Alcohol Use Disorders Identification Test; Care, Relax, Alone, Forget, Friends, Trouble (CRAFFT); and Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression Sexuality and Safety (HEEADSSS), while standardized tests appropriate for 96161 include the Safe Environment for Every Kid; Caregiver Strain Index; and Edinburgh Postnatal Depression Scale, according to Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas. Forecasting the future is hard []. "JavaScript" disabled. Using Alcohol Screening and Brief Intervention to Address Patients Do your [], Heres your guide to risk-free screening and assessment coding. How to bill for brief substance and alcohol abuse services Payment policies and claims edits are constantly changing and should be systematically monitored. A healthcare provider administers a skin cancer risk assessment questionnaire to a patient with a history of sunburns and tanning bed use. "CPT Copyright American Medical Association. of the Medicare program. However, some payers may reimburse for this service. Author disclosure: no relevant financial affiliations disclosed. "JavaScript" disabled. recipient email address(es) you enter. Health Risk Assessment Codes and How to Use Them This article is being retired effective for dates of service on and after 12/08/2022 because the related LCD is being retired. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). This article describes three steps to seamlessly implement aSBI into your practice: 1) Establish a practice workflow, 2) Incorporate aSBI prompts into your electronic health record (EHR) system, 3). It is conducted through health focused interviews, observations, and clinical decision making. 27) Encounter for routine child health exam with abnormal findings Depression Screening (pg. Applications are available at the American Dental Association web site. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom All comments are moderated and will be removed if they violate ourTerms of Use. not endorsed by the AHA or any of its affiliates. Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. Staff administer and score two structured screening instruments for development and autism. A summary of the discussion between the provider and patient regarding the results and any recommendations for managing or reducing identified health risks.