Coding Guidelines for Screening Tools Primary Care Final

1 Billing Guidelines for Developmental and Mental Health Screening and Assessment in Primary Care Table 1: Pediatric Screening /Assessments in Healthy Kids Preventive Health Schedule Recommendation from Examples of Acceptable Billing Guidelines Limitations Healthy Kids Preventive Standardized Tools Health Schedule Post-partum Screening recommended Patient Health 96161: Caregiver-focused 96161 will be reimbursed up to 4 units total depression at 1, 2, 4 and 6 month well Questionnaire-9 (PHQ- health risk assessment per child through age 12 months. 0 units will Screening child checks. Providers 9) may be billed only when a be reimbursed age 13 months and older. may pre-screen with Edinburgh Postnatal standardized Screening PHQ-2 to determine if a Depression Scale (EPDS) tool is used. PHQ-2 may longer standardized not be billed.

2 Screening tool is needed. Billing should occur under child's MA number Developmental Surveillance Ages and Stages 96110: Developmental 96110 will be reimbursed up to 8 units total Screening recommended at every Questionnaires (ASQ) Screening may be billed per child through age 5 years. 0 units will be well child visit; use of Parents' Evaluation of only when a standardized reimbursed age 6 years and older. standardized Screening Developmental Status Screening tool is used and tool required for all (PEDS) results documented A maximum of 2 units of 96110 will be children at 9, 18 and 24 reimbursed per visit when both a general months (and whenever developmental screen and an autism screen concern). are conducted; OR. 96110 may be combined with other Screening codes when appropriate (ex.)

3 96127) for a maximum of 2 units of Screening reimbursed per visit Autism Surveillance Modified Autism 96110: Developmental 96110 will be reimbursed up to 8 units total Screening recommended at every Checklist in Toddlers, Screening may be billed per child through age 5 years. 0 units will be well child visit; use of Revised with Follow-up only when a standardized reimbursed age 6 years and older. standardized Screening (MCHAT-R/F): 16-30 Screening tool is used and tool required for all months results documented A maximum of 2 units of 96110 will be children at 18 and 24 reimbursed per visit; OR. months (and whenever Recommendation from Examples of Acceptable Billing Guidelines Limitations Healthy Kids Preventive Standardized Tools Health Schedule concern). 96110 may be combined with other Screening codes (ex.

4 96127) for a maximum of 2 units of Screening per visit Mental health/ Annually beginning at 3 Pediatric Symptom 96127: Brief emotional/ A maximum of 2 units of 96127 will be behavioral years of age. Use of Checklist (PSC-Y) behavioral assessment reimbursed per visit; OR. assessment standardized Screening Strengths and may be billed only when a tool is recommended. Difficulties standardized Screening 96127 may be combined with other Screening Questionnaire (SDQ) tool is used and results codes (ex. 96110) for a maximum of 2 units of Ages and Stages documented Screening per visit Questionnaire Social Emotional (ASQ-SE). Early Childhood Screening Assessment Depression Screening recommended PHQ-9 Modified for 96127: Brief emotional/ A maximum of 2 units of 96127 will be Screening annually beginning at 11 Teens behavioral assessment reimbursed per visit; OR.

5 Years of age. If providers Pediatric Symptom may be billed only when a choose, they can pre- Checklist (PSC-Y) standardized Screening 96127 may be combined with other Screening screen with PHQ-2 to Center for tool is used and results codes (ex. W7000) for a maximum of 2 units determine if a longer Epidemiological Studies documented. PHQ-2 may of Screening per visit standardized Screening Depression Scale for not be billed. tool is needed. Children (CES-DC). Beck Depression Inventory (BDI). Substance use Annually beginning at 11 CRAFFT W7000: Alcohol and/or A maximum of 1 unit of W7000 will be assessment years of age; use of brief CAGE-AID substance use disorder reimbursed annually for recipients age 11. Screening tool is Screening may be billed and up recommended. only when a standardized Screening tool is used and W7000 may be combined with other Positive screens should be results documented.

6 Screening codes (ex. 96127) for a maximum followed by brief of 2 units of Screening per visit intervention and referral W7020: Intervention; > 3. for treatment when minutes up to 10 minutes A maximum 4 interventions will be indicated (SBIRT: reimbursed annually per recipient age 11 and Screening , Brief W7021: Intervention; >10 up Recommendation from Examples of Acceptable Billing Guidelines Limitations Healthy Kids Preventive Standardized Tools Health Schedule Intervention, and Referral minutes up to 20 minutes to Treatment). W7022: Intervention; >20. minutes Table 2: Other Pediatric Mental Health Screening /Assessments Recommendation Examples of Acceptable Billing Guidelines Limitations Standardized Tools ADHD AAP clinical policy Vanderbilt ADHD 96127: Brief emotional/ A maximum of 2 units of 96127 will be Assessment recommends use of Diagnostic Rating Scales behavioral assessment reimbursed per visit ADHD-focused parent and Parent and Teacher may be billed only when a teacher ratings scales as a Conners-3 Ratings standardized Screening component of Scales tool is used and results Screening /diagnosis when ADHD Rating Scale-5 for documented.

7 There is concern Children and Adolescents Other disorder- Disorder-focused mental Screen for Childhood 96127: Brief emotional/ A maximum of 2 units of 96127 will be focused mental health Screening and Anxiety Related behavioral assessment reimbursed per visit health assessment Tools may be Disorders (SCARED) may be billed only when a Screening / used when there is a Spence Children's standardized Screening assessment specific concern, ex. Anxiety Scale tool is used and results anxiety documented. Table 3: Adult Screening /Assessments for Mental Health and Substance Use Recommendation Examples of Acceptable Billing Guidelines Limitations Standardized Tools Depression Standardized Screening Patient Health 96127: Brief emotional/ 96127 may be combined with other Screening Screening tool is recommended; if Questionnaire-9 (PHQ- behavioral assessment codes (ex.))

8 W7000) for a maximum of 2 units providers choose, they 9) may be billed only when a of Screening per visit can pre-screen with Beck Depression standardized Screening PHQ-2 to determine if a Inventory (BDI) tool is used and results longer screen is needed documented. PHQ-2 may not be billed. Substance Use Standardized Screening Alcohol Use Disorders W7000: Alcohol and/or A maximum of 1 unit of W7000 or W7010 will Screening tool is recommended Identification Test substance use disorder be reimbursed annually for recipients age 11. (AUDIT) Screening , self- and up Positive screens should be Drug Abuse Screening administered may be followed by brief Test (DAST) billed only when a W7000 and W7010 may be combined with intervention and referral Alcohol, Smoking, and standardized self- other Screening codes (ex.

9 96127) for a for treatment when Substance Involvement administered tool is used maximum of 2 units of Screening per visit indicated (SBIRT: test (ASSIST). Screening , Brief CRAFFT (under 21) W7010: Alcohol and/or A maximum of 4 interventions will be Intervention, and Referral substance use disorder reimbursed annually per recipient age 11 and to Treatment) Screening , provider up administered may be billed only when a standardized provider administered tool is used W7020: Intervention; > 3. minutes up to 10 minutes W7021: Intervention; >10. minutes up to 20 minutes W7022: Intervention; >20. minutes Procedure Codes Code Description Current reimbursement 2017. 96110 Developmental Screening (eg. developmental milestone survey, speech and language $ delay screen) with scoring and documentation, per standardized instrument 96127 Brief emotional/behavioral assessment (eg.

10 Depression inventory, attention deficit/ $ hyperactivity disorder scale), with scoring and documentation, per standardized instrument 96161 Administration of caregiver-focused health risk assessment instrument (eg. depression $ inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument W7000 Alcohol and/or substance (other than tobacco) use disorder Screening ; self- $ administered W7010 Alcohol and/or substance (other than tobacco) use disorder Screening ; provider $ administered structured Screening (eg. AUDIT, DAST). W7020 Alcohol and/or substance (other than tobacco) use disorder intervention; greater than 3 $ minutes up to 10 minutes W7021 W7021: Alcohol and/or substance (other than tobacco) use disorder intervention; $ greater than 10 minutes up to 20 minutes W7022 Alcohol and/or substance (other than tobacco) use disorder intervention.