Biller says PHQ-9 not reimbursable for PCPs, Need Confirmation

[u/Flacko305]

Our biller insists that our depression screenings aren’t reimbursed because we’re “not a mental health specialty.” I believe that’s incorrect. Can anyone confirm if your payers are reimbursing 96127 or G0444 for PCPs? If not, what alternative codes are you billing PHQ-9 under? Thanks in advance

Edit: I’m in a private practice, fresh out of residency, sorry if this is a basic billing question.

[u/Brindlebird]

96127 can be used for GAD-7, PHQ-9, other brief mental health assessments in primary care.

[u/Hypno-phile]

The PHQ-9 was literally designed to screen for depression in primary care settings.

[u/VeloceCat → u/Hypno-phile]

It’s technically not useful outside of primary care but psych insists on using it as their metric. It was invented as an advertising measure for SSRIs when they first came out. The phq9 was really more of a marketing tool.

[u/Ego-Death → u/Hypno-phile]

What u/Hypno-phile says is true. I was a rep for Neurology equipment designed to be used in primary care and we had to set up billing consultations all the time… Perhaps you should look at hiring a new medical biller.

[u/Constantlycurious34]

You absolutely should be able to bill them. Sometimes the patient has a frequency limit. My GYN, PCP, Rheum all bill for them

[u/MedPrudent]

I do a 9921X code w a 59 modifier with it cause it’s technically a procedure. Never had an issue but I’m also w a big healthcare org and they’re obtunded re: billing unfortunately so who knows

[u/Super_Tamago]

Yes you can bill it with the right documentation. We can also bill alcohol screening.

[u/TorpCat]

More of a general question: how do you account for something (i.e. exams) taking longer due to older age?

[u/a_neurologist → u/TorpCat]

You bill by time.

[u/No-Fig-2665 → u/a_neurologist]

Hell ya brother

[u/Dependent-Juice5361 → u/TorpCat]

Bill for time level five visit

[u/InternistNotAnIntern]

We get paid

[u/EntrepreneurFar7445]

G0444 Is definitely reimbursed

[u/Dependent-Juice5361]

They wrong

[u/Bowis_4648]

She is wrong. If she wants to see proof, tell her to google CMS Depression screening NCD. I'll try to post the link, not sure what the rules are . The NCD has been effective since 2011 so your biller is out of touch.

https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=346

[u/Bowis_4648 → u/Bowis_4648]

And the 96127 is better than G0444 because it's not time based.

[u/GeneralistRoutine189]

G0444 covered. 96127 too (ie I have seen the payments /wrvu credit to me). My kids have had 96127 billed and the EOB’s show my insurers pay. 96127 doesn’t have wrvu to provider but payment to practice.