All rights reserved. For Medicare purposes, you also should not bill 96160 separately if furnished as a preventive service, because at that point it would describe a non-covered Medicare service." I ivygirl18@hotmail.com Networker apply equally to all claims. . Please contact the Medicare Administrative Contractor (MAC) who owns the document. If you dont find the Article you are looking for, contact your MAC. Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Documentation 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/scoring the instrument. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules. The following CPT codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time. The AMA assumes no liability for data contained or not contained herein. A healthcare provider administers a cardiovascular risk assessment questionnaire to a patient with a family history of heart disease. National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits do not bundle 96160 and 96161 into the office/outpatient evaluation and management (E/M) codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient ) or the preventive medicine E/M codes 99381-99396 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/established patient ), and no CPT regulations prohibit the services from being reported together. 4) Visit Medicare.gov or call 1-800-Medicare. The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. PDF Developmental Screening/Testing Coding Fact Sheet for Primary - CDC Are HRAs Bundled Into E/Ms or Other Services? Further Clarifications on the Use of 96160 and 96161 MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. Once youve answered the quiz [], Test Your Understanding of This MDM Element, Question: In the answer to question 2 in Take This Quiz, See if Your 2021 [], Choose These Codes for Post-COVID Sports Clearance, Question:Our pediatric office wants to put together a procedure for clearing patients post-COVID infections for [], Know These Requirements Before Billing Non-Face-to-Face Prolonged Services, Question: I know that 99358 is a standalone code that requires at least 30 minutes [], Rule in These Codes When Suspected Substance Symptoms Ruled Out, Question: If Mom smoked tobacco or abused substances during pregnancy, and the newborn does not [], Copyright 2023. There are no diagnosis code limitations being applied at this time. Additional Coding Considerations for Well Visits: 96110, 96127, 96160 Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. For more information, please visit ACOGs Solutions section (May 2015, Perinatal Depression). ET), 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Coding Question: Postpartum Depression Screening, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative. In addition, the physician must document that he or she reviewed the score in the context of the patient presentation and discussed the results with the patient/family as part of the related E/M service. When reporting multiple units of the same or different screening instruments, modifier 59, XE, XP, XS, or XU may be required to indicate distinct services. Developmental screening reported with code 96110 is paid for by 45 state Medicaid programs with rates varying from approximately $5 to $60.1 Many private insurers also provide preventive benefits for code 96110 for developmental screening at nine months, 18 months, and 30 months, and autism screening at 18 months and 24 months in addition to the recommended preventive medicine E/M services (e.g., well-child visits). You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. It is worth the effort to determine which payers in your area pay for these services. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Try entering any of this type of information provided in your denial letter. The submitted medical record must support the use of the selected ICD-10-CM code(s). *7. The requirements to report either 96160 or 96161 are as follows: Practice expense is incurred to administer the instrument (such as nurse time or for purchase of the screen). Get the Answers to Your Frequently Asked HRA Questions : Procedure Coding of the Medicare program. 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. THE UNITED STATES How Do 96160/96161 Differ From Each Other? Example B: Imagine the same scenario as in example A, but the patient has a different health plan. Report the additional CPT code (99202-99205 and 99211-99215) with modifier -25. Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. PDF EPSDT Program Billing Guide The list of results will include documents which contain the code you entered. 96161 is to be reported to the patient's health plan as it is a service for the benefit of the patient. article does not apply to that Bill Type. American Hospital Association ("AHA"), https://www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf. For assessments of specific risks such as caregiver strain, report code Z13.89. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.