One of my providers does a PHQ9 and a dependency screening with each physical. I know most doctors don’t think it is necessary, but this provider tells me they have seen so many patients who don’t bring up their mental health or substance abuse issues verbally during their medical visits. Those patients consistently have worse outcomes because the treatment often changes when taking those conditions into account. Doing the written tests with the physical allows patients to be truthful in a low stakes environment. Those tests are then scored and the results shared with the patient; whether they end up being positive or negative.
This is extra work. And if your providers do these, they deserve to be paid for that extra work.
Most insurances acknowledge that and pay separately. While CMS did just update their guidelines to state that the depression screening code G0444 is not payable with an annual wellness, insurances will still pay the PHQ9 separately with 96127.
But not United Healthcare. I found these guidelines from United Healthcare regarding their physical and screening policy and they are very straightforward. UHC is very clear that they believe codes G0444, G0442, 99408, G0396, G0447, and 99406 are included as part of a physical. If I sound irritated, it’s because I am. It is my job to ensure that my providers get paid for every service they perform. When my provider is taking 10-15 minutes more per physical on these two services, that is 10-15 minutes that they are not seeing other patients. That is an entire calendar slot that could be used for another patient.
There are two codes that are not on this excluded list that cover both a depression screening and a dependency screening and UHC will pay them separately about 60% of the time. Use S3005 for the depression screening and H0049 for the dependency screening. UHC will pay $24.00 for the S3005 and $10.00 for the H0049. Not always (because it depends on the patient’s plan) but $34.00 for 60% of the UHC screenings is better than $0.00 for 100% of the UHC screenings.
If you are having trouble getting your additional services paid, give me a call at (909) 610-9524 or send me an email at email@example.com and I’ll give you a hand.