Reproduced with permission. will not infringe on privately owned rights. This code is used when a healthcare provider administers a standardized questionnaire to a patient to help identify specific health risks, analyzes the results, assigns a score, and documents the findings. Compliance with the provisions in LCD L33834, Health and Behavior Assessment/Intervention may be monitored and addressed through post payment data analysis and subsequent medical review audits. CPT 96146: This code is used for the administration of a computerized adaptive psychological or neuropsychological test with a qualified health professionals interpretation and report. For example, the assessment might be done on a new mother to see if there is any problem, such as postpartum depression, that could affect the care of the patient, Bucknam adds. 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. Most payers allow two units (i.e., instruments) per date of service for code 96110. Example: An 18-month-old established patient is seen for a well-child exam. The physician reports code 99392 for the preventive service and two units of code 96110 for the administration of the structured screening instruments. recommending their use. You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. 96160 96161 CPT 96160, Under Health Behavior Assessment and Intervention Procedures The Current Procedural Terminology (CPT ) code 96160 as maintained by American Medical Association, is a medical procedural code under the range - Health Behavior Assessment and Intervention Procedures. Code 96160 is for the patient, who may have risks that impact their health but that have not yet been diagnosed, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. Quick reference: Screening and assessment codes, Screening Your Adult Patients for Depression, Childhood instrument-based screening for failure to develop and/or achieve skills according to the expected time frame (e.g., expressive and receptive language, motor skills), Ages & Stages Questionnaires Third Edition, Parents' Evaluation of Developmental Status, and Modified Checklist for Autism in Toddlers Revised With Follow-Up. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Use for developmental and autism screening. But some brief assessment instruments such as the Epworth Sleepiness Scale may be considered an HRA by some payers but bundled with a diagnostic E/M service by others, Hughes cautions. Health and behavioral assessment is an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. Neither the United States Government nor its employees represent that use of such information, product, or processes CPT code 96150 : Health and behavior initial assessment, each 15 minutes face-to-face with the patient CPT code 96151 : Health and behavior re-assessment, each 15 minutes face-to-face with the patient Deleted H&B Assessment Services (Effective 1/1/2020) 6 A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. Several CPT codes will be permitted through audioonly telehealth after 5/11/2023. The instrument is standardized. DISCLOSED HEREIN. Four codes are used to report structured screening and assessments: 96110, Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument,, 96127, Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument,, 96160, Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument,, 96161, Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument.. Modifier 33 may be required to indicate a service that may be preventive or diagnostic was provided as a preventive service. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. How Do 96160/96161 Differ From Other Screening and Assessment Codes? article does not apply to that Bill Type. *7. an effective method to share Articles that Medicare contractors develop. 2. Separate billing for scoring and report preparation is not allowed. Try using the MCD Search to find what you're looking for. The HRA codes are subject to PTP edits when reported with the other screening and assessment codes, however. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. Physicians should check with their specific payers. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Additionally, if a similar instrument is administered to a patients caregiver, such as for assessing the patients risk of developing depression, CPT code 96161 should be used instead. Documentation of a structured screening or assessment should include the date, patient's name, name and relationship of the informant (when information is provided by someone other than the patient), name of the instrument, score, and name and credentials of the individual administering the instrument. This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with "CPT Copyright American Medical Association. Save my name, email, and website in this browser for the next time I comment. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. Please visit the. No fee schedules, basic unit, relative values or related listings are included in CPT. Procedure Coding: Get the Answers to Your Frequently Asked HRA Questions, Get the Answers to Your Frequently Asked HRA Questions, Simply put, the two differ over who is being assessed. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. For more information, please visit ACOGs Solutions section (May 2015, Perinatal Depression). Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). apply equally to all claims. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The patient completes the questionnaire, providing information about their health and lifestyle. PDF Introduction to the 2020 Health Behavior Assessment and Intervention Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom

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