[Ohioaap-practicemanagers] Denials for Adolescent Depression Screening

[Beth Barker]

Just a quick FYI for those who are experiencing any issues with insurance coverage of adolescent depression screenings:


I received the following advice from key people on the AAP's committee whose new name is PAAC --Payer Advocacy and Advisory Committee and whose old name was PPAC --Private Payer Advocacy Committee.

   1) report the problem with the AAP's Hassle Factor Form so they can advocate for us on a national level: https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Pages/Hassle-Factor-Form-Concerns-with-Payers.aspx​. This form is much simpler than in the past.

  2) Be sure on the form to report which CPT code you've been using. FYI the proper code, 96127 (Brief Behavioral/Emotional Assessment) is a good topic for their advocacy. This is because this same code is also correct for reporting other tools such as Vanderbilt forms to manage ADHD. The rub is that adolescent depression screening at the annual well visit is preventative and therefore not subject to any patient responsibility in health plans covered by the Affordable Care Act. The same code used for Vanderbilts is not preventative and so is subject to deductibles, copays, and co-insurance.

   3) Be sure also to report which payers are giving you which hassles; e.g 'not a covered service' or 'included (bundled)' in the well visit code.

   Lastly, the reason the committee's name has changed is because they will be taking on our relationships with Medicaid managed care organizations as well as those with the commercial payers.



Thank you Dr. Price, this is very helpful!


Beth Barker BSN, RN
Director of Immunization Programs
Ohio Chapter,
American Academy of Pediatrics
Phone: 614-846-6258
Fax: 614-846-4025
Address: 94-A Northwoods Blvd. | Columbus, OH 43235
Website: OhioAAP.org<http://www.ohioaap.org/>


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