Administration and scoring of a short, standardized screening instrument for emotional or behavioral conditions, such as a depression or anxiety questionnaire, reported once per instrument.
- Medicare
- $5.01
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Name of each standardized instrument used (for example PHQ-9, GAD-7)
- Total score for each instrument
- Provider review of the result and interpretation
- Clinical action taken on a positive screen (referral, follow-up, surgical optimization plan)
- Number of units matching the number of instruments scored
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
96127 covers giving a patient a brief standardized questionnaire, scoring it, and documenting the result. Common instruments are the PHQ-9 for depression and the GAD-7 for anxiety. It is reported per instrument, so a PHQ-9 and a GAD-7 on the same day are two units.
Ortho practices use it more than they used to. Spine and joint replacement programs screen for depression and anxiety before surgery because both predict worse pain scores and slower recovery. Some bundled payment programs and surgical optimization pathways expect the screen in the chart. If your intake forms already collect a PHQ-9, the scored result can support this code when a provider reviews it.
What trips people up: the code pays for a scored, standardized tool, not a provider asking 'how is your mood.' The score and the instrument name must be in the note. Many payers cap units per day or per year, and some want modifier 59 when it is billed with other screening codes. When billed with an E/M visit, put modifier 25 on the E/M if the payer requires it.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0.14 |
| Malpractice RVU | 0.01 |
| Total RVU | 0.15 |
| Medicare national rate | $5.01 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $5.01 |
HOPD (APC 5732) Hospital outpatient department | $38.16 |
Common denial reasons
The recurring reasons claims for CPT 96127 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Units exceed payer daily or annual frequency limit
- No score or instrument name documented
- Billed for an informal mood question rather than a standardized tool
- Missing modifier 59 when payer edits it against other screening codes
- Payer does not cover screening for the diagnosis billed
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 96127 be billed more than once per day?
02Can an orthopedic surgeon bill 96127?
03Does 96127 need modifier 25 on the E/M?
04Is PHQ-2 billable with 96127?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe pulls the instrument name, score, and the provider's interpretation into the note, so a pre-op PHQ-9 or GAD-7 is documented the way 96127 requires.
See how Mira captures CPT 96127 documentation