CPT Code 96127: Brief Emotional/Behavioral Assessment

What is CPT code 96127?

CPT code 96127 reports a brief emotional or behavioral assessment performed using standardized instruments. Common tools include the Patient Health Questionnaire (PHQ-9), General Anxiety Disorder Scale (GAD-7), and Ages and Stages Questionnaire. These tools help mental health providers and other clinicians quickly screen for mental health concerns, such as depression, anxiety, ADHD, and other behavioral health conditions.

The 96127 CPT code description includes scoring and documentation of the assessment but does not cover interpretation or follow-up care. It can be used by a range of professionals, including primary care physicians, psychologists, and other mental health providers, as part of routine or targeted mental health services.

CPT code 96127 documentation requirements

To support accurate billing and ensure proper reimbursement, documentation for CPT 96127 must include:

• Name and type of standardized tool used: Clearly specify the assessment administered (e.g., PHQ-9, GAD-7, Vanderbilt ADHD scale, Ages and Stages Questionnaire, etc.).
• Reason for the assessment: Indicate clinical justification, such as addressing mental health concerns, routine screening, or evaluation of symptoms related to anxiety, depression, or behavior.
• Scoring and result: Include the raw score or outcome of the tool, with a brief summary in the patient’s record.
• Provider review and action: Document that the provider reviewed the result and incorporated it into the care plan or determined whether further mental health assessments or referrals are needed.
• Patient population and setting: Note the patient’s age and clinical context (e.g., pediatric well-check, behavioral consultation), which helps support mental health awareness and appropriate use of the tool.

CPT code 96127 billing guidelines

To maintain compliance and ensure accurate billing and reimbursement, behavioral health providers and mental health clinics should follow these key billing practices for CPT 96127:

• Billing multiple units: You can bill multiple units of CPT 96127 on the same day if different standardized assessments are used. The typical maximum is up to three units per patient per day, depending on payer policies.
• Modifier use may be required: When billing multiple units of 96127, some insurance providers may require the use of modifiers (such as modifier 59 mostly when payer-specific rules apply) or a detailed explanation in the medical documentation to distinguish each instrument’s purpose. This step is crucial to support standardized assessments and to avoid denials or claim delays.
• Coverage varies by payer: Each payer—including Medicare and Medicaid—may have different policies regarding 96127 billing. Some limit the number of instruments reimbursed per visit, while others may require that tools be used as part of comprehensive evaluations for mental health conditions or behavioral disorders. Providers must check individual payer guidelines to ensure accurate reimbursement.
• Not limited to mental health professionals: Although frequently used in mental health clinics, 96127 can be billed by primary care providers, pediatricians, and other qualified professionals who are addressing mental health concerns. The tool enhances behavioral health services across clinical settings by enabling early detection and treatment planning.
• Link to appropriate diagnosis codes: Always include a relevant ICD-10 diagnosis code to establish medical necessity, such as Z13.89 for encounters for screening for other disorders or F-codes for diagnosed mental health conditions. Accurate pairing of CPT and ICD-10 codes supports payer policies and enhances the defensibility of claims.

Other relevant codes

• 96110: Developmental screening and testing
• 96116: Neurobehavioral status exam
• 96130–96133: Psychological testing evaluation services
• 90791: Psychiatric diagnostic evaluation