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Elizabeth M. Whitehorn, Director

Provider Notice Issued 03/28/2023

Date:  March 28, 2023

To:   Enrolled Physicians; Physician Assistants; Advanced Practice Registered Nurses; Local Health Departments; Community Mental Health Centers; Behavioral Health Clinics; Licensed Clinical Social Workers; Licensed Clinical Psychologists; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and School Based/Linked Health Centers  

Re:   Coding Change for Depression Screenings Effective April 1, 2023

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This notice informs providers of coding changes to better identify outcomes of depression screening. These coding changes apply to claims for customers covered under the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs).

Providers have historically used procedure code 96127 to bill for a variety of screening services:
 
96127 - Brief emotional/behavioral assessment (e.g., depression inventory, eating disorders, suicide risk, anxiety, substance abuse, attention-deficit/hyperactivity disorder [ADHD] scale) with scoring and documentation, per standardized instrument.  

To better specify depression screening outcomes and the need for follow-up care, effective with dates of service beginning April 1, 2023, one of the following G codes must be used instead of 96127 to denote a depression screening has been performed and its result:

G8431: Screening for depression is documented as positive and a follow-up plan is documented
G8510: Screening for depression is documented as negative, a follow-up plan is not required

The rate for each G code will be the same rate as for 96127 on the applicable provider's fee schedule. Providers should continue to use CPT 96127 for non-depression screenings.

Questions regarding this notice should be directed to a billing consultant with the Bureau of  Professional and Ancillary Services at 1-877-782-5565 for FFS claims, or the applicable MCO.

 

Kelly Cunningham, Administrator

Division of Medical Programs