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Patients keep getting charged for crying

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Let’s back up—what the heck are CPT codes? Current Procedural Terminology (CPT) codes are an insane language of medical billing. They exist to assign value to every imaginable medical procedure and activity, from a physical exam to a circumcision. Providers use these codes to bill payers, like insurance companies or Medicare, or you, if you’re uninsured. Almost all medical care in the US is paid for with a fee-for-service model, which reimburses medical providers for care provided based on their activities, explaining why you get these bizarrely specific line items and inscrutable codes on your bill. These codes are extremely useful to know about if you ever want to challenge a medical bill, because you can easily find out how much Medicare reimburses providers for these billing codes using their Physician Fee Schedule search.

Using this tool, we can discover that Medicare pays between $4-6 for 96127, depending on location—ten times less than what the patient in the tweet was billed.

The fee-for-service model encourages providers to find more and more expensive codes to assign to their activities, spawning a whole industry of advice and expertise on how to “maximize revenue” through medical coding. I found a blog post on the site Therapy Notes specifically about using code 96127 to juice revenue:

96127 can be billed up to four times per client, per session. This means that you could administer, score, and bill for up to four separate instruments to each client every time they come in for a session. A brief survey of reimbursement rates across major insurance companies shows that you can earn an additional $4-$8 per instance of the code. Combining the 96127 code and MIPS payment adjustments, if a Medicare beneficiary comes in for 15 total sessions plus an intake, administering four instruments per visit and successfully reporting MIPS data could potentially increase your revenue for this client by nearly $400!  Check with your payers to see how this code is reimbursed.

This post seems to be encouraging therapists to administer four separate screening tools for different mental health diagnoses, every single session. I am no therapist, but I am depressed, and with each new provider I greet the 9-question depression screen like an old friend. I cannot see how filling it out every single session could possibly be a good use of the limited time you get with a therapist—let alone filling out three others too. If I didn’t have ADHD last week, I probably don’t have it this week. This sort of thing is a dark art for medical providers: When they do it wrong, that’s called upcoding, and it’s illegal. When they do it right, it’s just ‘maximizing revenue.’

“We need for-profit healthcare for innovation” here’s the innovation