96127
Hi,
For most payers, no report is required for use of a standardized instrument to assess emotional/behavioral status because the code descriptor states, with scoring and documentation, to indicate that no physician work (interpretation and report) was included in the value of services reported with this code. However, watch for certain payers that have interpreted the guidelines for central nervous system tests given in the prefatory text in this section of CPT. These payers won't cover the assessments unless the physician documents a brief report (e.g., score and interpretation based on patient presentation). The Medicaid Medically Unlikely Edits assign 2 units of service to code 96127 so additional medically necessary units (e.g., ADHD instrument completed by parent and two teachers) must be reported on separate claim lines (e.g., 2 units, 1 unit with modifier 59). For payers who use Medicare's MUE, only two units will be paid and others will be denied but you can appeal. Other payers have developed their own edits like United Healthcare's Maximum Frequency Per Day edits that also allow 2 units per day for 96127.
Bottom line, watch the payer's policies for this code.
Hope that helps.
Cindy