96127 bills one unit for each scored screening instrument
Medicare allows up to 4 units of 96127 a day, and Medicaid denies the code beside a psychotherapy code from the same clinician.
Co-founder, JotPsych
Your patients fill out a Patient Health Questionnaire-9 (PHQ-9) and a Generalized Anxiety Disorder-7 (GAD-7) before each visit. No 96127 shows on your claims. Bill each instrument your staff score and record.
Completed before the visit
Scored by trained staff: 14
Score in the visit's record
Completed before the visit
Scored by trained staff: 11
Score in the visit's record
From Noridian's Medicare mental health page, last updated June 8, 2026. Two scored instruments at one visit add two units of 96127 to the claim.
- Give each instrument, and have trained staff score it. Noridian, a Medicare contractor, says your trained administrative staff must give and score each instrument, such as the PHQ-9, GAD-7, or Depression Anxiety Stress Scales (DASS-21). You can bill instruments for attention-deficit/hyperactivity disorder (ADHD) and eating disorders too.
- Write each score in the visit's record. The 96127 descriptor includes scoring and documentation. You can't bill an instrument whose score isn't in the visit's record, even when your patient completed it.
- Count one unit for each instrument your staff score. Medicare allows up to 4 units of 96127 for your patient on one day. Medicare's medically unlikely edits set that limit.
- Check the visit code beside 96127. Medicaid's code-pair file pairs 96127 with every psychotherapy code from 90832 to 90853, add-on codes such as 90833 included, and with 90791 and 90792. Medicaid pays the other code and denies 96127, with or without a modifier, when one clinician bills both for one patient on one day.
| Code Medicaid pays, column one | Code Medicaid denies, column two | Modifier indicator |
|---|---|---|
| 90837 | 96127 | 0: Medicaid never pays both |
| 90834 | 96127 | 0: Medicaid never pays both |
| 90832 | 96127 | 0: Medicaid never pays both |
| 90791 | 96127 | 0: Medicaid never pays both |
| 90833 | 96127 | 0: Medicaid never pays both |
From Medicaid's practitioner code-pair file for October 1 to December 31, 2026. The file has no edit for 96127 with 99214, so a 99214 with no psychotherapy add-on can carry 96127.
Medicaid managed care plans may skip these edits, per the federal Medicaid edits page. Ask each plan you bill which edits it runs.
Noridian's page covers Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming, so check your own Medicare contractor's page in other states.
JotPsych's chart lists each PHQ-9 and GAD-7 score with its source and completion date.
Book 15 minutes- Noridian Healthcare Solutions, JF Part B, Mental Health, last updated June 8, 2026: 96127, per standardized instrument, with scoring and documentation. Read October 5, 2026.
- Centers for Medicare & Medicaid Services, Medicare National Correct Coding Initiative (NCCI) Medically Unlikely Edits: practitioner services file effective October 1, 2026 (96127). Read October 5, 2026.
- Centers for Medicare & Medicaid Services, Medicaid NCCI edit files: the practitioner procedure-to-procedure file for dates of service October 1 to December 31, 2026. Read October 5, 2026.
- Centers for Medicare & Medicaid Services, Medicaid NCCI, page last modified March 4, 2026: the edits are optional for managed care organizations. Read October 5, 2026.