Wiki Billing Medicare and CPT G0444 and CPT96127

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hbroome2

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Can someone clear up on how to bill Medicare for CPT Codes G0444 and 96127 (Diagnosis Z13.89 PHQ9 and DSM-v screenings ) for new, established and AWE. We seem to be getting denials when using the codes. Do they need a modifier and which ones can we bill. It seems that Commercial insurances are easier to bill with these codes than Medicare. Thanks!
 
hbroome2 said:
Can someone clear up on how to bill Medicare for CPT Codes G0444 and 96127 (Diagnosis Z13.89 PHQ9 and DSM-v screenings ) for new, established and AWE. We seem to be getting denials when using the codes. Do they need a modifier and which ones can we bill. It seems that Commercial insurances are easier to bill with these codes than Medicare. Thanks!
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You can not bill both 96127 & G0444. For Medicare you must bill G0444 for a depression screening with dx Z13.31, encounter for screening for depression. They will only pay for G0444 once a year.
 
jkyles said:
Hi there, that's a quality measurement code. There's no reimbursement for it.
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Hi, thanks for your response, but for example, I have these charges, but G0444 has already been billed within the last year causing this to be denied, do I remove the charge or add a modifier?
G0444 PR DEPRESSION SCREEN ANNUAL
99213 PR OFFICE OUTPATIENT VISIT 20-29 MINS
3077F,3078F,3725F,3288,3008F,1036F
 
Medicare will only cover 1 depression screening in a 12 month period for adults, there is no modifier that would bypass this limitation as it is a coverage issue not a coding issue. CMS has an NCD for Screening for Depression in Adults which clearly states this information and specifically states that screening for depression more than once in a 12 month period is non-covered.

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